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: Eligible Providers

Are you a Medicaid provider with a Certified EHR system? If so, it’s NOT too late to receive up to $63,750!! The deadline to attest to AIU and MU has been extended to March 31, 2017! Current and new Medicaid Providers who have purchased an EHR by December 31, 2016 are eligible. For more information on the Medicaid EHR Incentive program, email us at: ehrincentives@la.gov or Call a Medicaid EHR Specialist at 225-342-4810 or 225-342-7742.

ATTENTION PROVIDERS:

POLICY CLARIFICATION: Every provider is held responsible on the federal and state level for ensuring that their employees have not been excluded.

To determine if an employee or prospective employee is excluded on the state level, check the Louisiana Department of Health’s Adverse Actions website at the link below:

https://adverseactions.dhh.la.gov/

*Please note: The website should be checked upon hire and monthly thereafter.

This is a state database containing all individuals and providers who are excluded. You can search by name and verify with a Social Security Number (SSN) if you have one. Providers are required to maintain printed confirmation of the checks from the website as verification of compliance with this mandate. If the exclusion is learned prior to employment the provider should not employ the person or entity. If the provider learns of the exclusion after hiring the employee, the provider must notify the Louisiana Department of Health within 10 working days of discovering the exclusion. If you have any questions or comments or need to report an issue with an excluded worker or entity, please contact the Program Integrity Section via email at DHH.Medicaid.State.Exclusions@LA.gov.

There are additional mandatory checks that should be done – refer to your policy manuals, public health L.A.C. rules, remittance advice messages and provider updates for more information on the following websites: CNA-DSW State Registry, Office of Inspector General Office (OIG) national database, System for Award Management (SAM) national database.

Attention Louisiana Medicaid Providers:

Effective March 28, 2017, Fee-for-Service (FFS) Medicaid pharmacy claims for tasimelteon (Hetlioz®) and lumacaftor/ivacaftor (Orkambi®) will have Point of Sale (POS) edits and clinical pre-authorization requirements.

Please refer to www.lamedicaid.com for more information.

2017 HCPCS Claims Recycle

Louisiana Medicaid fee-for-service (FFS) claims processed from January 1, 2017 through March 3, 2017 that were denied due to use of the new 2017 procedure codes prior to their addition to the claims processing system and the updates made to the ‘ClaimCheck’ editing product will be recycled. Providers can expect to see the recycled claim results on the remittance advice of March 28, 2017. No action is required by providers.

The following claims are included in the recycle:

  • Home Health
  • Professional Services
  • Laboratory and Radiology
  • Ambulatory Surgical Centers (Non-Hospital)
  • Free Standing Rehabilitation
  • Take Charge Plus

Claims containing updates to immunization services will be recycled separately in the near future. Providers should monitor their RA messages for information regarding the recycling of the immunization claims.

Please contact Molina 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.