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.

REMINDER TO ALL DME AND PHARMACY PROVIDERS EMERGENCY PRIOR AUTHORIZATION REQUESTS

This is to advise that DHH has posted the procedures necessary to request prior authorization for medical equipment and supplies in emergency situations as a reminder to all providers of durable medical equipment and supplies to the LA Medicaid website at http://www.lamedicaid.com/.

If you have any questions regarding the procedures please contact Molina Prior Authorization Department at 225-928-5263 or 1-800-488-6334.

ATTENTION DURABLE MEDICAL EQUIPMENT PROVIDERS

Effectively immediately DME providers are being advised to discontinue distributing the Abbott Enteral Therapy Pumps, as DHH has been made aware that Abbott will be discontinuing their line of enteral pumps effective April 31, 2013.

This notice is to also advise that DHH will not be replacing any pumps unless the current pumps are no longer operable. DHH has been advised that supplies for the discontinued pumps are available through Covidien, therefore it is not necessary to replace any pumps that are fully operable.

Also, providers are cautioned not to attempt to retrieve the Abbott pumps from the recipient as the pumps were purchased by DHH and are now the property of the recipients.

ATTENTION ALL PROVIDERS 2013 HCPCS UPDATE

The Louisiana Medicaid files are currently being updated to reflect the new and deleted HCPCS codes for 2013. Once completed, a provider notice will be posted and claims that have been denied due to use of the new 2013 codes prior to their addition to our system will be systematically recycled.

Once this process is completed, providers will see claim denials of 2012 codes that are being deleted effective December 31, 2012. Those claims should be resubmitted with the correct 2013 code.

ATTENTION REHABILITATION CENTERS, OUTPATIENT HOSPITAL REHABILITATION AND SCHOOL-BASED HEALTH CENTERS

Effective March 1, 2013, the definition for procedure code(s) 92507 and 92508 are being updated to reflect the appropriate CPT code definition and remove the 15 minute increment as listed on the Louisiana Medicaid Fee Schedules.

The rates are being updated in accordance with the definition per occurrence/visit. Only one occurrence may be billed per day. Providers should check with the appropriate health plans for billing instructions on previous dates of service since implementation of Bayou Health, February 2012.

Please see the updated Rehabilitation Services Fee Schedule on http://www.lamedicaid.com/.

OUTPATIENT HOSPITAL PROVIDERS: PULSE OXIMETRY CLAIMS

Effective with the March 26, 2013 date of processing, outpatient hospital claims for noninvasive ear or pulse oximetry (CPT code 94760) will be processed through the ClaimCheck clinical editing product, and subject to the same editing as professional claims. Providers can expect that pulse oximetry claims will be considered integral/incidental to other allowed services performed on the same date and in most instances will not be separately reimbursed. This update provides consistency in Medicaid policy among provider types.

For questions related to this information, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.