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 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.

ATTENTION PROFESSIONAL AND HOSPITAL PROVIDERS
BILLING RADIATION ONCOLOGY SERVICES FOR MEDICARE CROSSOVER CLAIMS
Clarification on 'G' Code Billing

On May 15, 2015, DHH published a notice informing providers that the appropriate procedure codes to bill Louisiana Medicaid for certain radiation oncology services are CPT codes 77385-77387. The notice also indicated that the "G" codes currently used by Medicare are not payable by Louisiana Medicaid.

Based on updated information, DHH has determined that HCPCS codes G6002 – G6015 currently used to bill Medicare for these services will be loaded on the Medicaid file as payable for Medicare Crossover claims only. This will prevent the outright denial of claims where Medicare is the primary payer. The 'G’ codes will not appear on the published Medicaid fee schedule due to the fact that they are non-payable for straight Medicaid claims. Medicare cross-over claims for HCPCS codes G6002-G6015 with dates of service January 1, 2015 forward that were previously denied will be recycled. The recycle is expected to occur within the next few weeks. No action is required by providers.

Please remember that these "G" codes remain in non-pay status for Medicaid primary claims, and providers must bill the appropriate CPT codes for Medicaid services. Providers may resubmit straight Medicaid claims using the appropriate CPT codes for radiation oncology services for dates of service January 1, 2015 forward that denied due to the use of the 'G’ codes.

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