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 Hospital Providers:

Effective June 20, 2014, hospitals will receive an additional payment for the insertion of long-acting reversible contraceptives (LARCs) for women newly post-partum prior to discharge. The payment for the LARC will be equal to the fee on the DME fee schedule and will be in addition to the hospital's per diem payment. Providers may consult the DME fee schedule to see which LARCs are covered and their reimbursement.

For questions related to this information, please contact Molina Provider Services at (800) 473-2783 or (225) 924-5040.

Attention Hospital Providers:

Effective June 1, 2014, Louisiana Medicaid is removing the hospital emergency room three visit limit per calendar year. System changes have been completed so all claims for dates of service on or after June 1, 2014 will process correctly in reference to this change.

For questions related to this information, please contact Molina Provider Services at (800) 473-2783 or (225) 924-5040.

ATTENTION PROFESSIONAL SERVICES PROVIDERS:

The Professional Services Fee Schedule has been updated to reflect new HCPCS codes for 2014. This completes the annual HCPCS update for 2014. Claims that denied due to the use of the 2014 codes prior to their addition to the procedure file will be systematically reprocessed on the Remittance Advice (RA) of June 10, 2014. No action is required by providers.

For questions related to this recycle, please contact Molina Medicaid Provider Services at (800) 473-2783 or (225) 924-5040.

Oncotype DX Breast Cancer Assay Coverage:

Effective with date of service, July 1, 2014, Oncotype DX Breast Cancer Assay via Genomic Health, Inc. will be reimbursed by the Louisiana Medicaid program. This assay provides a prediction of chemotherapy benefit in women with certain early stage breast cancers.

Please see www.lamedicaid.com for complete details related to coverage and billing information for Oncotype DX Breast Cancer Assay.

Attention Professional Service, DME, and Pharmacy Providers: Revision of Insulin Pump Criteria

Payment for a continuous subcutaneous insulin external infusion pump and related supplies will be authorized for treatment of Type I diabetes when Medicaid recipients meet certain criteria. Effective with date of service June 1, 2014, Louisiana Medicaid has revised their Insulin Pump medical criteria guidelines to reflect current industry standards.

Please visit www.lamedicaid.com to view the web posting for complete details.