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: Provider Portal Login Update on LAMEDICAID.com
On Friday September 21, 2018, Molina will install an enhanced version of its
provider portal on LAMEDICAID.com in partnership with the Louisiana Department of
Health. With your first login, you will be required to update your password,
profile, and answer three security questions. Please take this opportunity to
update your user information such as email address and phone number. For security
purposes, the Provider Applications page has been simplified to display
applications based on information such as provider type, specialty, and enrollment
status.
Attention Louisiana Medicaid Providers:
Effective September 18, 2018, the Louisiana Medicaid Fee for Service (FFS) Pharmacy
Program will implement Clinical Prior Authorization requirements for
tezacaftor/ivacaftor (Symdeko®), mepolizumab injection (Nucala®), reslizumab
injection (Cinqair®), and benralizumab injection (Fasenra®). Please refer to
www.lamedicaid.com for more information.
Attention Louisiana Medicaid Providers:
Effective October 1, 2018, Fee for Service (FFS) Medicaid and Medicaid Managed
Care Organizations (Aetna, AmeriHealth Caritas, Healthy Blue, Louisiana Healthcare
Connections, and United Healthcare) will implement an educational alert at Point of
Sale (POS) requiring a diagnosis code for oral contraceptives. Please refer to
www.lamedicaid.com for more information.
Attention Louisiana Medicaid Providers:
Effective September 14, 2018, Fee-for-Service (FFS) Medicaid Pharmacy Program will
reimburse enrolled pharmacies for influenza vaccines and the administration of the
vaccines by a pharmacist per program policy. For more information, please refer to
http://www.lamedicaid.com/provweb1/Pharmacy/Influenza.htm.
Attention Louisiana Medicaid Providers:
Effective September 26, 2018, Fee for Service (FFS) Medicaid will implement an edit
at Point of Sale (POS) for a therapeutic duplication when opioid prescriptions are
written by different prescribers. Please refer to
www.lamedicaid.com for more information.
Attention Louisiana Medicaid Providers:
Effective September 26, 2018, Fee for Service (FFS) Medicaid will implement an edit
at Point of Sale (POS) for a drug to drug interaction between sacubitril/valsartan
(Entresto®) and Angiotensin-Converting Enzyme (ACE) Inhibitors. Please refer to
www.lamedicaid.com for more information.
ATTENTION: ICF/IID FACILITIES
The USC, CFR, and La Medicaid State Plan require that the claim. defined as a single document line identifying the services and/or charges for services for a single recipient
from a single provider, be submitted to Louisiana Medicaid for payment within 12 months from the date of service and that the claim be paid no later than 12 months from the date
of receipt of the claim. Failure to bill within the allotted period will result in the nonpayment of claims.
In addition, the Louisiana Department of Health strongly encourages providers to bill monthly and to attempt to clear any denials received within two billing periods.