PHARMACY PROVIDERS, PLEASE NOTE!!!

The Outpatient Pharmacy Drug Search will allow providers and external users to search for payable drugs submitted as pharmacy claims. The Outpatient Pharmacy Drug Search is available here.

The Medicaid program will cover only products of the manufacturers, which participate in the Federal Rebate Program.

If additional information is needed about a drug product, please contact the Gainwell Help desk at 1-800-648-0790.

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.

Fee Schedule and Fee Schedule Legend Enhancements

Louisiana Medicaid is standardizing Medicaid fee schedules to enhance the provider experience and comply with new CMS payment rate transparency requirements. Additional fields will be incorporated into the fee schedules and associated legends will be being modernized.

For more information about the enhancements, please visit this website https://www.lamedicaid.com

If you have questions about this information, please contact Gainwell Technologies Provider Services at (800) 473-2783 or (225) 924-5040.

2025 HCPCS and Physician-Administered Drug Reimbursement Updates

The Louisiana Medicaid fee-for-service (FFS) files have been updated to incorporate the new and revised Healthcare Common Procedure Coding System (HCPCS) codes effective for services rendered on or after January 1, 2025.

Louisiana Medicaid is also updating reimbursement rates within the FFS files for physician-administered drugs (PADs) under Professional Services, effective January 1, 2025. New rates for PADs that require a wholesale acquisition cost will be phased in over the upcoming weeks.

For more information regarding the above or the related claims recycle, please refer to the web notice titled accordingly, available on the LAMedicaid.com homepage.