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 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.

Attention Providers
Genetic Testing for Breast and Ovarian Cancer

Effective with dates of service July1, 2016 and forward, Louisiana Medicaid will now cover genetic testing for BRCA 1 and BRCA 2 mutations in cancer-affected individuals and cancer-unaffected individuals. Louisiana Medicaid considers it to be medically necessary if the recipient meets the published criteria. For Fee For Service (FFS) members, genetic testing for breast and ovarian cancer must be prior approved by the fiscal intermediary’s Prior Authorization Unit (PAU). Information regarding this policy can be found on www.lamedicaid.com under the Provider Manuals link within the Professional Services Manual and the fee schedule can be found within the Professional Services Fee schedule under Laboratory and Radiology section.

Please contact the appropriate Managed Care Organization if there are any questions concerning their policies and prior authorization processes for their members. In addition, questions regarding legacy Medicaid should be directed to Molina Provider Relations at (800) 473-2783 or (225) 924-5040.

Attention Fee for Service (FFS) Louisiana Medicaid Providers:

Effective September 15. 2016, Fee-for-Service (FFS) Medicaid Pharmacy Program will reimburse enrolled pharmacies for influenza vaccines and the administration of the vaccines by a pharmacist p er program policy. For more information, please refer to http://www.lamedicaid.com/provweb1/Pharmacy/Influenza.htm.