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 ICF Providers, Nursing Home Providers and Hospice Providers
CMS required billing changes

Transaction standards updated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) with regard to ASC Xl2 Version 5010 require an attending provider be submitted on all institutional (format UB-04) claims. Effective July 1, 2015, all claims submitted for payment must identify the attending physician and all appropriate blocks on the claim form must be completed with the attending physician's identifying information. There will be no exceptions to this change. An edit will be put into the system to deny/reject any and all claim forms with missing required information.

Please visit www.lamedicaid.com for detailed provider notices concerning these changes.

Attention Hospital and Independent Lab Providers
Coverage and Reimbursement Guidelines for CPT code 81220:

Effective for dates of service January 1, 2012 and forward, CPT (Current Procedural Terminology) code 81220 CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; common variants) will be reimbursed by Louisiana Medicaid. Previously denied claims due to the procedure code not being on file will be systematically recycled without any action required by the provider on the RA of May 26, 2015.

The reimbursement for any lab testing that occurs during a recipient’s inpatient hospitalization (at a recipient’s birth or if hospitalized at a later date) is included in the per diem rate paid to the hospital by Medicaid. This includes CPT code 81220 when performed on hospitalized newborns immediately after birth. If a hospital contracts the services of an independent lab to perform lab services during a member’s inpatient hospitalization, the hospital is responsible for payment of these services to the independent lab. The independent lab may not bill Medicaid directly for payment of these services.

Hospitals are allowed by Medicaid to contract with an independent laboratory for performance of outpatient laboratory services including CPT code 81220 when performed as a repeat screening for a newborn. When a hospital contracts with a freestanding laboratory for the performance of the technical service only, it is the responsibility of the hospital to pay the laboratory.

ATTENTION PROFESSIONAL SERVICES PROVIDERS:
IMMUNIZATION FEE SCHEDULE UPDATES

Although Current Procedural Terminology (CPT) code 90633(Hepatitis A vaccine, pediatric/adolescent dosage-2 dose schedule, for intramuscular use) has been a covered service, it has not been displayed on the Immunization Fee Schedule for children and adolescents. The Immunization fee schedule has been updated to correctly display Hepatitis A vaccine for 0-18 years of age.

Effective with date of service June 1, 2015, CPT code 90634(Hepatits A vaccine, pediatric/adolescent dosage-3 dose schedule, for intramuscular use) will no longer be covered by the Louisiana Medicaid program. This vaccine is no longer provided by the Vaccines for Children (VFC) program.

Effective with date of service May 1, 2015, CPT code 90651(Human Papilloma virus vaccine types 6, 11, 16, 18, 31, 45, 52, 58, nonavalent, 3 dose schedule for intramuscular use) will be covered by the Louisiana Medicaid program for ages 9-26. The VFC will be providing this vaccine for recipients under the age of 19.

The Immunization Fee Schedules have been updated on the Louisiana Medicaid website at www.lamedicaid.com to reflect these changes.

Please contact Molina Provider Relations (800)473-2783 or (225) 924-5040 for questions regarding Immunizations.