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 Fee for Service (FFS) Louisiana Medicaid Providers:

Effective July 10, 2017, Fee-for-Service (FFS) pharmacy claims for opioid prescription products exceeding 120 MME (Morphine Milligram Equivalent) will deny at Point of Sale (POS). Prescribers can apply for an override of the denial by faxing an Opioid Analgesic Treatment Worksheet to 1-866-797-2329. Also, short-acting opiate prescription claims will be subject to a 7 day quantity limit for opioid naïve recipients. Please refer to www.lamedicaid.com for more information.

Attention Fee for Service (FFS) Louisiana Medicaid Providers:

Effective June 27, 2017, Fee-for-Service (FFS) Medicaid pharmacy claims will have the following clinical edits at Point of Sale (POS). Prescriptions for triptans will require an ICD-10-CM diagnosis code submitted in NCPDP field 424-DO (Diagnosis Code) for recipients less than 18 years old. Prescriptions for olmesartan/amlodipine/hydrochlorothiazide (Tribenzor®) and amlodipine/valsartan/hydrochlorothiazide (Exforge HCT®) will require prior drug use of two select antihypertensive drug therapies. Please refer to www.lamedicaid.com for more information.

ATTENTION PROVIDERS
PAYMENT ERROR RATE MEASUREMENT (PERM) 2017 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, CNI Advantage.

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.

ATTENTION PROVIDERS OF HOSPICE SERVICES:
Hospice Rate Adjustment: Federal Fiscal Year (FFY) 2017

Louisiana Medicaid has updated its published fee schedule to reflect the adjusted reimbursement rates and Metropolitan Statistical Area (MSA) codes for the provision of Hospice services as determined by CMS for FFY 2017. The updated rates and MSA codes are effective for dates of service on or after October 1, 2016.

Providers should begin submitting claims using the updated MSA codes for dates of service on or after July 1, 2017. Providers may resubmit previously paid claims for dates of service October 1, 2016 through June 30, 2017 with the corrected MSA codes for payment adjustment.

For questions regarding this message and/or fee for service claims, please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040.

Updates to Healthy Louisiana related to systems and claims processing changes are plan specific and are the responsibility of each health plan. For questions regarding Healthy Louisiana updates, please contact the appropriate health plan.