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 PROVIDERS:

POLICY CLARIFICATION: Every provider is held responsible on the federal and state level for ensuring that their employees have not been excluded.

To determine if an employee or prospective employee is excluded on the state level, check the Louisiana Department of Health’s Adverse Actions website at the link below:

https://adverseactions.dhh.la.gov/

*Please note: The website should be checked upon hire and monthly thereafter.

This is a state database containing all individuals and providers who are excluded. You can search by name and verify with a Social Security Number (SSN) if you have one. Providers are required to maintain printed confirmation of the checks from the website as verification of compliance with this mandate. If the exclusion is learned prior to employment the provider should not employ the person or entity. If the provider learns of the exclusion after hiring the employee, the provider must notify the Louisiana Department of Health within 10 working days of discovering the exclusion. If you have any questions or comments or need to report an issue with an excluded worker or entity, please contact the Program Integrity Section via email at DHH.Medicaid.State.Exclusions@LA.gov.

There are additional mandatory checks that should be done – refer to your policy manuals, public health L.A.C. rules, remittance advice messages and provider updates for more information on the following websites: CNA-DSW State Registry, Office of Inspector General Office (OIG) national database, System for Award Management (SAM) national database.

Providers of Clinical Laboratory Services - Fee Reimbursement Changes

Federal regulations prohibit state Medicaid agencies 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 adjusted on the fee-for-service Medicaid file and are effective for dates of service January 1, 2017 forward. The Laboratory Fee Schedule has been updated to reflect those changes.

Clinical laboratory claims for dates of service on or after January 1, 2017 where the previous reimbursement exceeded the Louisiana Medicare allowable rate will be systematically recycled on the remittance of May 9, 2017 without any action required by the provider.

Please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040 if there are questions related to this matter for fee for service claims.

Louisiana Medicaid Fee Schedule Publishing Change

Beginning April 28, 2017, the published Medicaid fee-for-service fee schedules for Professional Services, Laboratory/Radiology, and Take Charge Plus will be refreshed by Molina on a weekly basis. (Previously these fee schedules were refreshed monthly.) This change was implemented to inform both providers and managed care organizations (MCOs) of Medicaid fee-for-service procedure file updates in a more timely manner.

These and the other published fee schedules are found on the Louisiana Medicaid website, www.lamedicaid.com using the ‘Fee Schedule’ link.

ATTENTION HOSPITAL PROVIDERS:

Rate increases for certain non-rural, non-state hospitals have been approved effective for dates of service 1/1/17 due to the provisions contained in HRC 51 of the 2016 Legislative Session. These rate increases are now posted online at lamedicaid.com under "fee schedules".

As a result, previously processed claims with dates of service after 1/1/17 will be recycled/adjusted on the remittance advice of May 9, 2017 without any action required on behalf of the provider.

Questions regarding this message should be directed to Molina Provider Relations at (800) 473-2783 or (225) 924-5040.

Institutional Providers Provider Disallowance

Health Management Systems, (HMS), on behalf of the Louisiana Department of Health (LDH), Medical Vendor Administration, has implemented an Institutional Provider Disallowance Project. Federal law requires that LDH recover Medicaid payments made to providers when a liable third party is identified. If it is determined that your office or facility was paid for claims provided to Medicaid beneficiaries who may have been eligible for other commercial health coverage on the dates of service, you will be notified by HMS and will be included in a Disallowance Project Cycle. HMS will provide you with a list of beneficiaries, their associated claims, any potential coverage and instructions on what you need to do.

In accordance with Act 517 of the 2008 Regular Session of the Louisiana Legislature, providers are now able to bill Medicaid-reclamation claims to carriers up to thirty-six (36) months from the date of service.

LDH encourages all providers to utilize HMS' Provider Portal. The portal was designed to process disallowances on-line. The Provider Portal offers many benefits such as: immediate receipt of disallowance notifications, elimination of paper listings, real-time access to disallowance projects, up-to-date claim status, and on-demand reporting. If you wish to self-register, please go to https://ecenter.hmsy.com for additional information or call HMS’s Provider Operations Department toll-free at 888-831-2738. They will assist with your registration to the portal and information on upcoming web-enabled instructional training seminars. LDH recommends all providers to opt out of receiving paper listings in the future and only use the Provider Portal for disallowance projects. The Provider Portal offers and ensures the protection of all PHI associated with these projects.

Professional Providers Provider Disallowance

Health Management Systems, (HMS), on behalf of the Louisiana Department of Health (LDH), Medical Vendor Administration, has implemented a Professional Provider Disallowance Project. Federal law requires that LDH recover Medicaid payments made to providers when a liable third party is identified. If it is determined that your office or facility was paid for claims provided to Medicaid beneficiaries who may have been eligible for other commercial health coverage on the dates of service, you will be notified by HMS and will be included in a Disallowance Project Cycle. HMS will provide you with a list of beneficiaries, their associated claims, any potential coverage and instructions on what you need to do.

In accordance with Act 517 of the 2008 Regular Session of the Louisiana Legislature, providers are now able to bill Medicaid-reclamation claims to carriers up to thirty-six (36) months from the date of service.

LDH encourages all providers to utilize HMS' Provider Portal. The portal was designed to process disallowances on-line. The Provider Portal offers many benefits such as: immediate receipt of disallowance notifications, elimination of paper listings, real-time access to disallowance projects, up-to-date claim status, and on-demand reporting. If you wish to self-register, please go to https://ecenter.hmsy.com for additional information or call HMS’s Provider Operations Department toll-free at 888-831-2738. They will assist with your registration to the portal and information on upcoming web-enabled instructional training seminars. LDH recommends all providers to opt out of receiving paper listings in the future and only use the Provider Portal for disallowance projects. The Provider Portal offers and ensures the protection of all PHI associated with these projects.