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.

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.

ATTENTION PROVIDERS
PAYMENT ERROR RATE MEASUREMENT (PERM) 2021 IS NOW IN PROGRESS

Louisiana Medicaid is mandated to participate in the Centers for Medicare and Medicaid (CMS) Payment Error Rate Measurement (PERM) program which will assess our payment accuracy rate for the Medicaid and CHIP programs. If chosen in a random sample, your organization will soon receive a Medical Records Request from the CMS review contractor, AdvanceMed. This cycle measurement will review Medicaid and CHIP payments made in Reporting Year (RY) 2021: July 1, 2019 through June 30, 2020.

Please be advised that sampled providers who fail to cooperate with the CMS contractor by established deadlines may be subject to sanctioning by Louisiana Medicaid Program Integrity through the imposition of a payment recovery by means of a withholding of payment until the overpayment is satisfied, and/or a fine.

Please be reminded that providers who are no longer doing business with Louisiana Medicaid are obligated to retain recipient records for 5 years, under the terms of the Provider Enrollment Agreement.

For more information about PERM and your role as a provider, please visit the Provider link on the CMS PERM website: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/PERM/Providers.html

All providers on Medicare crossover claims receiving 444 Invalid Service Provider denials

For a portion of claims receiving error code 444, the denial was erroneous due to the system evaluating the provider type and specialty on the crossover claim instead of just the enrollment status. Additionally, claims that were submitted with a blank provider field were also denied with error code 444 on Medicare crossovers in error. Gainwell has adjusted the application of the 444 error code and all claims originally erroneously denying will be systematically recycled and paid the week of July 12, 2021. Providers with denied claims for error code 444 do not need to resubmit the claim for payment, payment will be automatically issued for those eligible. Medicare crossover claims will continue to be denied if any of the providers listed on the claim, including the attending provider, are not enrolled. Further information can be found at LAMEDICAID.COM.