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:

PAYMENT ERROR RATE MEASUREMENT (PERM) 2014 PROVIDER EDUCATION WEBINARS

The Centers for Medicare & Medicaid Services (CMS) will be hosting PERM Provider Education Conference Calls/Webinars this summer, to provide interactive sessions for providers of Medicaid and Children's Health Insurance Program (CHIP) services. Providers will be informed about PERM updates, trends and responsibilities. There will be opportunities to ask questions and provide feedback to CMS and your state representatives.

For Webinar details, refer to the March/April, 2014 Provider Update Article, located in the Provider portal at www.lamedicaid.com.

Attention Intermediate Care Facility Providers

Effective April 1, 2014 the Provider Fee for Intermediate Care Facilities (ICF) days will increase from $14.30 to $16.15 as allowed by Louisiana Revised Statute 46:2625. Future Quarterly Fee Reports issued by the Department will reflect this change. Medicaid is awaiting CMS approval for the rate increase. Once this increase is approved DHH will recycle claims to pay you the increased rate associated with the fee increase.

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid:

Effective May 30, 2014, diagnosis codes will be required on pharmacy claims for select specialty drugs. Please refer to www.lamedicaid.com for the complete list with appropriate diagnosis codes.

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid:

Effective May 30, 2014, pharmacy claims for Victrelis® (boceprevir), Incivek® (telaprevir), Sovaldi® (sofosbuvir), and Olysio® (simeprevir) will have therapeutic duplication and early refill edits applied. Please refer to www.lamedicaid.com for specifics.

ATTENTION HOSPITAL PROVIDER OF OUTPATIENT REHABILITATION SERVICES:

We recently learned that some outpatient hospital rehabilitation services billed for children under 3 years old are paying at an incorrect rate. This only included a few isolated codes. This problem has been identified, corrected, and affected claims are systematically adjusted on the 5/27/14 RA. Please reconcile these adjustments appearing on the RA, and if you have other affected claims that were not identified in this systematic process, please submit an adjustment for processing. We apologize for any inconvenience.