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) 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 OUTPATIENT HOSPITAL SERVICES PROVIDERS:

During a recent claims processing system update, it was noted that the reimbursement for immunizations to outpatient hospital services providers was incorrect. The referenced processing error resulted in an overpayment to providers. This error has been corrected. Affected claims will be adjusted resulting in a recovery of the overpayments without any action on behalf of the provider. This adjustment will be included on the RA for Tuesday, August 22, 2017.

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 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.

ATTENTION PORTABLE RADIOLOGY PROVIDERS:

The claims processing system has been updated to reflect new codes reimbursable to portable radiology providers beginning with dates of service January 1, 2016 going forward. Previously denied claims will be reprocessed for payment where appropriate without any action required on behalf of the provider. Payments will be reflected on the RA of September 5th, 2017.

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 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.

Attention Fee for Service (FFS) Louisiana Medicaid Providers:

Effective September 12, 2017, Fee-for-Service (FFS) pharmacy claims for opioid prescription products exceeding 90 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. Please refer to www.lamedicaid.com for more information.