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.

For information regarding the medication policy and/or criteria associated with this denial, providers may access the Louisiana Medicaid Preferred Drug List (PDL) / Non-Preferred Drug List at http://ldh.la.gov/assets/HealthyLa/Pharmacy/PDL.pdf.

Attention Louisiana Medicaid Providers:

Effective September 15, 2019, 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. If FFS Medicaid pharmacy program is billed for a recipient 18 years old or younger, only the administration fee will be reimbursed since the influenza vaccine is available through Louisiana Vaccines for Children (VFC) program. For more information, please refer to http://www.lamedicaid.com/provweb1/Pharmacy/Influenza.htm.

Attention Federally Qualified Health Centers (FQHC)
and Rural Health Clinic (RHC) Providers

LDH has received confirmation from the Centers of Medicaid and Medicare Services that state Medicaid programs can consider behavioral health services provided by Licensed Professional Counselors and Licensed Marriage and Family Therapist as “other” ambulatory services in a RHC or FQHC facility. Provider manual and systems changes will be published to allow reimbursement to these providers in a RHC or FQHC setting. This change will be retroactively effective 4/1/2019.

All FQHC and RHC providers should review the Informational Bulletin at http://www.ldh.la.gov/index.cfm/page/1198 for additional information regarding this change.

Information regarding this change is forthcoming and will be located on www.lamedicaid.com under the Provider Manuals link, within the FQHC and RHC Provider manual.

Questions regarding this notice and fee for service claims should be directed to DXC Technology Provider Relations at (800) 473‐2783 or (225) 924‐5040.

Attention Louisiana Medicaid Providers:

Effective October 1, 2019, Fee for Service (FFS) Medicaid and Managed Care Organizations (MCOs) will implement updated clinical edits for opioids and antipsychotic agents. Please refer to www.lamedicaid.com under pharmacy and prescribing providers to access the document.