PHARMACY PROVIDERS, PLEASE NOTE!!!

If you are unsure about the coverage of a drug product, please contact the PBM help desk at 1-800-648-0790.

Please file adjustments for claims that may have been incorrectly paid. Only those products of the manufacturers which participate in the Federal Rebate Program will be covered by the Medicaid program. Participation may be verified in Appendix C, available at http://www.lamedicaid.com. 

Should you have any questions regarding any of the following messages, please contact Molina Medicaid Solutions at (800) 473-2783 or (225) 924-5040.

Attention Physicians and Independent Laboratories
2019 Clinical Laboratory Services - Reimbursement Changes

Under Federal regulation, state Medicaid agencies are prohibited from reimbursing providers of clinical laboratory services at a higher rate than the Medicare allowable rate. In accordance with this regulation, clinical laboratory reimbursement rates have been updated on the fee-for-service Medicaid file effective for dates of service January 1, 2019 and forward. The Laboratory and Radiology fee schedule has been updated to reflect those changes.

Clinical laboratory claims for dates of service on or after January 1, 2019, where the previous reimbursement exceeded the Louisiana Medicare allowable rate will be systematically recycled on the remittance of March 19, 2019 without any action required by the provider.

Please contact DXC Technology Provider Relations at (800) 473-2783 or (225) 924-5040 if there are questions related to this matter for fee for service claims.

Questions related to the Healthy Louisiana managed care organizations' updates should be directed to the specific health plan.

Attention Louisiana Fee for Service (FFS) Medicaid Providers:

On March 14, 2019, Fee for Service (FFS) Medicaid implemented Point of Sale (POS) Clinical Pre-Authorization for Multiple Sclerosis treatment agents. Please refer to www.lamedicaid.com for more information.

Attention Louisiana Fee for Service (FFS) Medicaid Providers:

On March 14, 2019, Fee for Service (FFS) Medicaid implemented Point of Sale (POS) Clinical Pre-Authorization for Granulocyte Colony Stimulating Factor (GCSF) agents and updated diagnosis codes for incobotulinumtoxinA (Xeomin®). Please refer to www.lamedicaid.com for more information.

ATTENTION: Professional Service Providers: FFS Claim Denials Reprocessed

LDH identified inapproptiate claim denials for edit 047 (ordering provider required) with dates of services from April 1, 2017 thru January 23, 2019. These claims will be reprocessed on the March 26, 2019 check write.

Please contact DXC Provider Relations at 225-924-5040 or l-800-473-2783 for questions related to this announcement.

ICD-10 UPDATE: External Cause of Injury Diagnosis Codes (Diagnosis Codes Beginning with V, W, X or Y) Are now Billable as Non-Primary Diagnosis Codes

Beginning with dates of service on and after September 4, 2018, Louisiana Medicaid will accept external cause of injury ICD10 codes when reported as non-primary diagnosis.

FFS claim denials for invalid diagnosis codes (edit 433) for external cause of injury code when reported in the non-primary diagnosis field will be recycled for payment on April 1, 2019.

Going forward, claims filed with an external cause of injury code as a primary diagnosis will be denied with Edit 020.

Please refer to CMS 1500 and UB 04 billing instructions located on LAMedicaid.com: https://www.lamedicaid.com/provweb1/billing_information/medicaid_billing_index.htm

If you have questions about the contents of this RA, you may contact DXC Provider Relations at 1-800-473-2783 or refer to www.lamedicaid.com.