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
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.

ATTENTION PROVIDERS
Breast Reconstruction Post Mastectomy

Effective with dates of service October 1, 2016 and forward, Louisiana Medicaid will now cover breast reconstruction post mastectomy of the contralateral unaffected breast for recipients diagnosed with breast cancer. Previously, Louisiana Medicaid only covered breast reconstruction post mastectomy on the affected/diseased breast. Breast reconstruction post mastectomy 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.

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

ATTENTION: Eligible Providers

Hurry! If you don’t begin participation in the Medicaid Electronic Health Records Incentive Program by December 31, 2016, you’ll miss out on $63,750 in incentive payments. Please visit the website at http://new.dhh.louisiana.gov/index.cfm/page/1159 for information. A new redesigned web portal will be ready for attestations starting September 19, 2016 at https://LAConnect.ThinkHTS.com. If you need additional information, please contact Kelli Douglas at 225-342-7742 or Gary Dillon at 225-342-4810.

Update to 'ClaimCheck' Product Editing

McKesson's 'ClaimCheck' product is routinely updated by the McKesson Corporation based on changes made to resources used, such as Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) coding guidelines, the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule database, National Correct Coding Initiative (NCCI) edits, and/or provider specialty society updates. The 'ClaimCheck' product's procedure code edits are guided by these widely accepted industry standards.

This update will affect claims with remittance advice of September 13, 2016 forward. Providers may notice some differences in claims editing. Providers should expect that some claims will continue to deny for the same error, but in some cases claims may now pay or deny for a different reason.

For questions related to this information as it pertains to fee-for-service Medicaid claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.

Attention Providers
Information Regarding Intranasal Flu Vaccine for 2016-2017

Please note that the CDC’s Advisory Committee on Immunization Practices (ACIP) recommends that the nasal spray flu vaccines should not be used during the 2016-2017 flu season. ACIP continues to recommend annual flu vaccination with either the inactivated influenza vaccine or the recombinant influenza vaccine for everyone 6 months and older.

Louisiana Medicaid, in conjunction with information from the CDC and the Louisiana Office of Public Health Immunization Program advises that only the injectable flu vaccine will be available for VFC and other providers this year. The nasal flu vaccines are non-covered effective immediately. Fee schedules will be updated to reflect this change.

For questions related to this information as it pertains to fee-for-service Medicaid claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040. Please contact the appropriate Managed Care Organization for any questions concerning their policies and processes.