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 Gainwell Technologies at (800) 473-2783 or (225) 924-5040.

For information regarding the medication policy and/or criteria associated with this denial, providers may access the Louisiana Medicaid Preferred Drug List (PDL) / Non-Preferred Drug List at http://ldh.la.gov/assets/HealthyLa/Pharmacy/PDL.pdf.

PROVIDER NOTIFICATION

For Claims denied with Edit 032, 291, 296, or 590 and pending for 296, click here.

ATTENTION PROVIDERS:

LDH has updated its payment processing method to "Same Day ACH" as of March 18, 2025. For Same Day ACH payments, processing may occur at different times throughout the business day due to bank processing windows. Be aware that payment may be delayed if federal funds are not received by distribution date/time.

Attention Durable Medical Equipment (DME) Providers

Effective with dates of service on or after April 3, 2025, the Prior Authorization screen for providers on www.lamedicaid.com will share the reasons for denial as they appear on the beneficiary’s denial and partial denial letters.

DME providers requested access to this data to expedite provider’s submission of requested documentation to obtain prior authorization approval for medically necessary equipment and services.

No action is required by providers to access the data. The data will appear at the bottom of the Prior Authorization Review screen automatically when the provider logs in to review requests.

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