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.

CHANGES TO DME, HOME HEALTH, REHABILITATION AND PERSONAL CARE SERVICES DUE TO THE AUGUST 2016 FLOOD IN AFFECTED PARISHES

Medicaid recipients who live in one of the declared disaster parishes caused by the August 2016 flooding, and who need to replace equipment or supplies previously approved by Medicaid, may contact either a Medicaid enrolled or Health Plan contracted durable medical equipment (DME) provider of their choice to obtain a replacement. For Medicaid enrolled providers, the provider must make a request to Molina’s Prior Authorization Unit; however, a new prescription and medical documentation are not required. The provider shall submit the required Prior Authorization Form (PA-01) along with a signed letter from the recipient giving a current place of residence and stating that the original equipment or supplies was lost due to the August 2016 flood.

Additionally, recipients who were approved to receive medical equipment, supplies, Home Health services, Rehabilitation or Personal Care services from a provider in an affected parish who is no longer in business or unable to provide the approved equipment, supplies or services, may obtain the approved items from a new provider of their choice provided that the provider is enrolled in Medicaid or contracted with a Health Plan. The original authorization will be canceled and a new authorization will be given to the new provider. For Medicaid enrolled providers, the provider will need to submit the required Prior Authorization Form with a signed letter from the recipient requesting a change in providers and giving his or her current place of residence.

All other prior authorization requests for equipment, supplies, and medical services will require a prescription from a doctor and documentation to establish medical necessity.

This policy is applicable for residents in the following affected Parishes:

Acadia, Allen, Ascension, Assumption, Avoyelles, Cameron, East Baton Rouge, East Feliciana, Evangeline, Iberia, Iberville, Jefferson Davis, Lafayette, Livingston, Pointe Coupee, St. Charles, St. Helena, St. James, St. John the Baptist, St. Landry, St. Martin, St. Tammany, Tangipahoa, Vermilion, Washington, West Baton Rouge, and West Feliciana.

Attention Medicaid Providers: Administrative Correction Voids processed in August 30, 2016 payment cycle

LDH has processed voids for paid Fee-For-Service claim records that were also paid by MCO Plans. The duplicate claim payments are associated with Recipients who were retrospectively enrolled into an MCO Plan. Since the Billing Provider has already been paid by the MCO Plan for these FFS voids, no further claim submission by the Billing Provider is required. These voids will be reported in the August 30, 2016 payment cycle using EOB 999 (Administrative Correction).

For questions related to this information please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.

Attention Fee for Service (FFS) Louisiana Medicaid Providers:

Effective September 6, 2016, FFS pharmacy claims for suvoxerant (Belsomra®), brexipiprazole (Rexulti®), paliperidone (Invega Trinza®), and aripiprazole (Aristada®) will have Point of Sale (POS) edits. Please refer to www.lamedicaid.com for specifics.