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 Hospice Care Providers and Agencies:

Effective immediately, providers now have up to 5 calendar days to submit the Notices of Revocation, Discharge, Transfer and Void to the Prior Authorization Unit (PAU) at DXC Technology.

Providers are reminded that failure to submit Notices of Revocation, Discharge or Transfer in a timely manner can result in the inability for other providers to bill for Medicaid services. Late submissions will be monitored by the department and PAU, and may be subject to monetary penalties.

Information regarding this policy can be found on www.lamedicaid.com under the Provider Manuals link, within the Hospice provider manual.

Questions regarding this message and fee-for-service claims should be directed to DXC Technology Provider Relations at (800) 473-2783 or (225) 924-5040.

Questions related to managed care claims should be directed to the appropriate Managed Care Organization (MCO).

Attention Enteral Nutrition and Oral Supplement Providers

Effective May 1, 2019, and with dates of service forward, Louisiana Medicaid will no longer cover the Nutrabalance Protein Cookies listed under HCPCS code B4153 on the DME Enteral Nutrition Fee Schedule.

The following National Drug Codes (NDCs) will no longer be available in the DME program:

07249122006
07249191003
07249191005
07249191009
07249551804
07249551807

Providers must reach out to prescribing physicians and recipients to determine a replacement alternative as a source of protein for recipients. LDH is requesting that providers work with DXC Technology to cut back prior authorizations and reduce units in order to submit new prior authorizations that include the physician’s replacement source of protein for recipients. DXC Technology was instructed not to approve new prior authorization for the NutraBalance protein cookie past dates of service 4/30/2019.