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 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.

ATTENION PROVIDERS OF RUM SERVICES

With the implementation of Bayou Health, RUM authorizations were being rejected back to MSI if the authorization period overlapped the Bayou Health effective date for the recipient.  This caused claims to deny, also.  MSI has retransmitted the majority of the rejected authorizations, but there are still some outstanding.  On this RA (08/14/12), Molina has recycled claims that were denied for edit 190 (no PA) for dates of service 02/01/12 forward in an attempt to allow any claims to process where the authorization has been successfully received from MSI.  Since some authorizations are still outstanding, only claims with approved and successfully re-transmitted authorizations were recycled to process through the system.  Some of these claims will deny again for appropriate edits other than edit 190.  Hopefully, this will allow payment of many claims involved and let providers know the status of those not recycled.  Once all authorizations are successfully re-transmitted, a final claims recycle will occur. We apologize for the inconvenience this has caused providers.

NOTICE TO ALL PHYSICIANS PROVIDERS CONSULTATION CODES ARE NO LONGER BILLABLE

Effective July 1, 2012, Medicaid will no longer recognize office and other outpatient consultation codes (99241-99245) and inpatient consultation codes (99251-99255).

With date of services July 1, 2012 physicians should adhere to current concurrent care-inpatient policy as outlined in the Professional Service Manual, section 5.1. Providers should bill the appropriate subsequent hospital care code when rendering these services in the hospital setting. Only the admitting provider may submit a claim for one of the initial hospital care codes per a recipient's inpatient stay. Therefore use of the AI modifier when billing the appropriate E/M codes for the services rendered will not be necessary.