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 Ordering Providers and Providers of Laboratory Services

Effective for dates of service on or after July 1, 2019, Louisiana Medicaid has adopted the following changes to the coverage of Urine Drug Testing:

  • Presumptive drug testing is limited to 24 total tests per member per calendar year. Providers are to consider the methodology used when selecting the appropriate procedure code for the presumptive testing

  • Definitive drug testing is limited to 18 total tests per member per calendar year. CPT codes 80320-80377 for individual substance(s) or metabolites will no longer be covered. Providers should instead use HCPCS codes G0480 (Drug tests, definitive…per day 1-7 drug class(es), including metabolite(s) if performed) or G0481 (Drug tests, definitive…per day, 8-14 drug class(es), including metabolite(s) if performed) or their successors.

Testing more than fourteen definitive drug classes per day is not reimbursable.

No more than one presumptive and one definitive test will be reimbursed per day per recipient, from the same or different provider.

Information regarding this policy is forthcoming and will be found on www.lamedicaid.com under the Provider Manuals link, within the Professional Services and Independent Laboratory Services manuals. Fee schedules will be updated accordingly and can be found at the appropriate link on www.lamedicaid.com.

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 regarding managed care claims should be directed to the appropriate Managed Care Organization.

Attention Providers of Laboratory Services

Effective for dates of service on or after August 1, 2019, Louisiana Medicaid will require all providers to include a valid Clinical Laboratory Improvement Amendments (CLIA) number on all claims submitted for laboratory services. Claims submitted with an absent, incorrect or invalid CLIA number will deny.

For claims submitted using the CMS-1500 form, the CLIA number will be required in block 23. Providers should refer to the CMS 1500 Billing Instructions under the Billing Information link at www.lamedicaid.com, where complete instructions will be provided.

Information regarding this policy change is forthcoming and will be found on www.lamedicaid.com under the Provider Manuals link, within the Professional Services and Independent Laboratory manuals.

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 regarding managed care claims should be directed to the appropriate Managed Care Organization.

Attention Obstetricians and Gynecologists

The Office of Population Affairs (OPA) has updated and published a new Sterilization Consent form (HHS 687), with an expiration date of 4/30/2022. This new form is effective immediately. Any previous forms must have had a valid expiration date at the time of signature in order to be accepted by DXC Technology.

Providers can access the most current Sterilization Consent form at www.lamedicaid.com, under the Forms/Files/Surveys/User Manuals tab, or by visiting the U.S. Department of Health and Human Services (HHS) website directly at https://www.hhs.gov/opa/sites/default/files/consent-for-sterilization-english-updated.pdf.

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 regarding managed care claims should be directed to the appropriate managed care organization.

Attention Louisiana Medicaid Providers:

On May 1, 2019, Fee for Service (FFS) Medicaid and Managed Care Organizations (MCOs) implemented the Louisiana Medicaid Single Preferred Drug List (PDL). Please refer to http://ldh.la.gov/assets/HealthyLa/Pharmacy/PDL.pdf to access the document.

Attention Louisiana Medicaid Providers:

On May 1, 2019, Louisiana Medicaid updated the pharmacy reimbursement policy for Fee for Service (FFS) and Managed Care Organizations (MCOs) local pharmacies. The ingredient cost reimbursement is based on the National Average Drug Acquisition Cost (NADAC). The maximum allowable professional dispensing fee for all pharmacies in FFS and local pharmacies in MCOs changed from $10.41 to $10.99.

Attention Louisiana Medicaid Providers:

On May 1, 2019, Fee for Service (FFS) Medicaid implemented Point of Sale (POS) Clinical Pre-Authorization for methadone and updated the maximum daily dose for buprenorphine agents to 24mg/day for FFS and Managed Care Organization (MCO) enrollees. Please refer to www.lamedicaid.com for more information.