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.

Billing of Shared Plan Claims to Molina after July 31, 2015

Claims for Bayou Health Shared Savings Plan members formerly enrolled in CHS or UHC with dates of prior to February 1, 2015, should be submitted for payment to the appropriate Shared Savings Plan no later than July 31, 2015. After July 31, 2015, claims for these members must be submitted directly to Molina for payment. Claims submitted to CHS and UHC after July 31, 2015 will deny with edit 998 “submit claim to Molina for processing”.

When submitting claims to Molina, please adhere to the instructions below:

  • Hard Copy Claims – Use billing instructions provided for your provider/claim type found at http://www.lamedicaid.com/provweb1/billing_information/medicaid_billing_index.htm. Reminder: Always submit claims with the 13 digit Medicaid Recipient ID and 7 digit Legacy Medicaid provider number for billing and servicing providers when submitting claims to Molina. Include appropriate attachments and/or proof of timely filing if necessary.
  • Electronic Claims – Use the appropriate 837 electronic transaction in the 5010 HIPAA Companion Guide for your provider/claim type found at http://www.lamedicaid.com/provweb1/HIPAA/5010v_HIPAA_Index.htm. Again, always submit claims with the 13 digit Medicaid Recipient ID number.

If you have any questions, please contact Molina’s Provider Relations at 1-800-473-2783.

Attention Pharmacists and Prescribing Providers of Louisiana Legacy Medicaid:

Effective July 15, 2015, a new EOB of 346 will be implemented for Fee For Service (FFS) pharmacy claims. This will impact the Medicare/Medicaid Dual Eligible recipients. EOB 346—Bill Medicare Part B for qualified services otherwise bill Medicare Part D; Bill Medicare Part D/B (short message). The drug categories included are oral anti-emetics, oral chemotherapy, ESRD agents, immune globulins, immunosuppressants, and inhalation solutions.

Attention Pharmacists of Louisiana Medicaid (Fee For Service and Managed Care):

NCPDP field 481-HA (flat tax field) has been identified for the placement of the $0.10 provider fee. Please begin submitting the $0.10 provider fee in this field on July 24, 2015 for all pharmacy Medicaid claims, Fee For Service and Managed Care.

Attention Pharmacists of Louisiana Medicaid Fee for Service:

Effective July 24, 2015, reimbursement of the dispensing fee and provider fee will be itemized out separately on Fee for Service pharmacy claims. Dispensing fee will be remitted at a maximum allowable of $10.41 in NCPDP field 507-F7 (dispensing fee paid). Provider fee will be remitted at $0.10 per paid claim in NCPDP field 558-AW (flat sales tax paid). Previously, both the dispensing fee and provider fee were remitted together at a maximum allowable of $10.51 in NCPDP field 507-F7 (dispensing fee paid).

ATTENTION LABORATORY PROVIDERS:

Coverage of the professional component for Current Procedural Terminology (CPT) code 88361 (Morphometric analysis…computer assisted…) has recently been added by Louisiana Medicaid. This change is effective for dates of service on or after January 1, 2014. The laboratory fee schedule has been updated to reflect this change. Previously denied claims for the professional component on CPT code 88361 due to non-coverage will be systematically recycled on the RA of July 28, 2014 without any action required on behalf of the provider.

Please contact Molina Provider Relations (800) 473-2783 or (225) 924-5040 if you have any questions regarding this matter.