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 www.lamedicaid.com. 

Attention Pharmacy Providers

Effective 05/02/2012 copay logic has been modified to calculate & deduct the copayment amount from the amount allowed for recipients enrolled in the following waiver programs: "Support Waiver", "Residential Options Waiver", and "Community Choice Waiver" programs. (See Section 37.6.5 of "Louisiana Medicaid Program Provider Manual").

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

TO BAYOU HEALTH PROVIDERS ONLY IN GSA-A (Regions 1 and 9)
AND GSA-B (Regions 2, 3, 4)
UPDATE TO VERIFYING FUTURE MONTH HEALTH PLAN & ELIGIBILITY
INFORMATION FOR BAYOU HEALTH MEMBERS ONLY

DHH has completed revisions that will allow future month Health Plan and eligibility information to be shown in MEVS and e-MEVS. Revisions allow providers to obtain future enrollment information for dates of service up to 3 months. However, Plan Enrollment into a BAYOU HEALTH Plan may be prospective, and a recipient's eligibility for coverage under a Plan may be subject to change. Therefore, to ensure that you are using accurate and up-to-date eligibility information, it is your responsibility to re-check eligibility status with e-MEVS and your MEVS vendor prior to and on the date of service. If you fail to do so, and if you consequently provide services to a recipient who is ineligible on the date of service, you will not be paid for those services.

IMPORTANT NOTICE TO ALL MEDICAID HOSPICE PROVIDERS

The Department of Health and Hospitals will partner with Molina Medicaid Solutions to administer the Medicaid Hospice Program. Effective May 1, 2012, Hospice providers are to appropriately submit all hospice prior authorization requests and related forms to:

Molina Medicaid Solutions via e-PA System @www.lamedicaid.com

Please check the lamedicaid.com website for upcoming webinar training dates. Questions regarding hospice prior authorizations should be directed to Molina's Prior Authorization Unit at 1-800-877-0666, option 2, effective May 1, 2012.

ATTENTION LOUISIANA MEDICAID PROVIDERS

The Louisiana Medicaid Nurse Helpline will be discontinued effective Monday, April 30, 2012, at 5:00pm. This service was provided through the contract for administration of the CommunityCARE and KIDMED programs. BAYOU HEALTH plans will assume responsibility for providing this service to their members as the program is implemented into each of the three Geographic Service Areas (GSA) of the state.

Members are to call:

Amerigroup - 1-800-600-4441
Community Health Solutions - 1-855-247-5248
LaCare - 1-888-756-0004
Louisiana Healthcare Connections - 1-866-595-8133
United Healthcare Community Plan - 1-866-675-1607

Providers in GSAs A and B should immediately remove all references to the Louisiana Medicaid Nurse Helpline from patient literature and office messaging. Providers in GSA C, the final area of the state scheduled for BAYOU HEALTH implementation, must have this process completed by April 30th.

THE FOLLOWING 6 MESSAGES ARE DIRECTED TOWARDS
BAYOU HEALTH PROVIDERS IN GSA-C (REGIONS 5, 6, 7, and 8)

1. ATTENTION LOUISIANA MEDICAID PROVIDERS

Effective for dates of service on or after 6/1/2012, claims for Medicaid State Plan Services provided to BAYOU HEALTH Plan members, must be submitted to the Health Plan the member is linked to. If they are billed directly to Molina, the claims will deny, advising you to submit the claim to the Health Plan. Claims for carved out services not covered under BAYOU HEALTH Plans will continue to be billed to Molina. For further information, visit the website at www.makingmedicaidbetter.com. Click on the Providers link, and review the list of carved out services located on the 'Medicaid Provider Billing Changes for Dates of Service beginning June 1, 2012' document.

2. ATTENTION PRIMARY CARE PROVIDERS (PCPs)

Have you enrolled with a BAYOU HEALTH Plan yet? If not, starting 6/1/12, you will no longer receive reimbursement for providing services to Louisiana Medicaid recipients enrolled in a BAYOU HEALTH Plan unless you have contracted with or made other arrangements with a BAYOU HEALTH Plan. For further information, visit the website at www.makingmedicaidbetter.com or participate in daily phone calls being held Monday through Friday with DHH by calling 1-888-278-0296, passcode 7299088.

3. ATTENTION LOUISIANA MEDICAID PROVIDERS

The CommunityCARE and KIDMED programs are ending statewide with the implementation of BAYOU HEALTH. As BAYOU HEALTH phases into a Geographic Service Area (GSA), CommunityCARE and KIDMED linkages for enrollees residing in the GSA'S have been terminated.

There will be no new CommunityCARE or KIDMED provider enrollment KIDMED enrollees transitioning into BAYOU HEALTH will be the responsibility of the individual Health Plans.

Existing PCPs are notified of the procedure for ensuring uninterrupted medical care for transitioning CommunityCARE/KIDMED enrollees as BAYOU HEALTH implementation begins in the GSA. Notices for GSA C may be viewed at: www.makingmedicaidbetter.com, or www.lamedicaid.com.

4. ATTENTION COMMUNITYCARE PROVIDERS

Current CommunityCARE Primary Care Providers (PCPs), that intend to continue rendering care to Louisiana Medicaid recipients as PCPs in the BAYOU HEALTH program, must ensure that each Health Plan is provided with the 7-digit Medicaid legacy provider ID and corresponding NPI enrolled in CommunityCARE. PCPs with CommunityCARE linkages at more than one location must also include the appropriate 3-digit site number for each enrolled location.

NOTE: Physician group practices, FQHCs, and RHCs must also provide the Medicaid IDs and NPIs for the individual practitioners at each CommunityCARE-enrolled location.

5. VERIFYING HEALTH PLAN & ELIGIBILITY INFORMATION FOR BAYOU HEALTH MEMBERS

Effective 4-1-2012, REVS, MEVS, and E-MEVS applications will show the name of the BAYOU HEALTH PLAN and their phone number for Medicaid recipients enrolled in BAYOU HEALTH. Enrollment in a BAYOU HEALTH Plan is for the entire calendar month. This information will be located where current CommunityCare PCP information is and will no longer contain the PCP name. You may obtain PCP information from the BAYOU HEALTH Plan.

6. ATTENTION LOUISIANA MEDICAID PROVIDERS

Effective May 1, 2012, CommunityCARE and KIDMED referrals/authorizations will no longer be required. Claims for services provided to enrollees with dates of service in May 2012 will bypass the CommunityCARE 106 and KIDMED 424 error edits when billed to Louisiana Medicaid.

ATTENTION HOSPITAL PROVIDERS

Revenue code 278 requires the use of a HCPC code with the revenue code. Revenue code 279 does not require the use of a HCPC code with the revenue code.

FAMILY PLANNING WAIVER TAKE CHARGE PROVIDERS

As a result of updates to the 2012 CPT Codes, effective 12/31/2011, CPT codes 11975 (Insertion or Reinsertion, Implantable), 11976 (Removal of an Implantable Contraceptive Capsule), and 11977 (Removal with Reinsertion, Implantable) are no longer payable under the Family Planning Waiver "Take Charge Program." Please use CPT codes 11981 (Insertion, Non-Biodegradable Drug Delivery Implant), 11982 (Removal, Non-Biodegradable Drug Delivery Implant) and 11983 (Removal with Reinsertion, Non-Biodegradable Drug Implant) as appropriate. These changes are effective as of 1/1/2012. Please re-submit any denied claims related to these procedure codes with the correct 2012 CPT Code.

IMPORTANT NOTICE TO ALL MEDICAID HOSPICE PROVIDERS

The Hospice Service Manual and related forms have been updated and revised. Requirements and procedures have changed regarding the election of hospice services. The revised manual and forms can be reviewed online at www.lamedicaid.com -> Provider Manuals.

Providers may begin using the revised forms upon reviewing the revised manual. The older version of the forms will become obsolete effective June 1, 2012. Older versions of the forms will not be accepted after this date. Providers must follow the new procedures when submitting requests for hospice services. Failure to adhere to the new requirements may cause a delay in processing a request for hospice services.