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.

Home and Community Based Services - Recycle of Claims Due to Post Authorization Adjustments

A recent audit identified home and community based service (HCBS) claims that overlapped in payment with service claims submitted by other HCBS providers. In response to this discrepancy, affected providers have submitted service claim adjustments to make appropriate corrections.

When the providers submitted an adjustment claim to repay the units billed in error, they received an edit 194 (Claim Exceeds Prior Authorized Limits) claim denial. In order to remedy this, Molina changed how post authorized service units are applied to service claim adjustments.

On the RA of 9/29/15, Molina will recycle these denied claims from date of service July 1, 2014 that will allow repayment through the Molina billing adjustment process.

Future service claim adjustments submitted by providers should process correctly.

Providers who received an edit 194 claim denial for claim adjustments which added units to be paid must resubmit the claims to Molina. However claims for increased units will not be paid until all blocked units for the Prior Authorization on the claim have been resolved by the provider.

ATTENTION PROVIDERS OF ‘TAKE CHARGE PLUS’ SERVICES ICD-10 CODING

Take Charge Plus offers a limited benefit package of family planning and family planning-related services. With the exception of the services billed by pharmacists, all services must be submitted using an appropriate primary diagnosis.

For Dates of Service prior to 10/01/15, the ICD-9 Diagnosis Codes in Appendix A of the Take Charge Plus provider manual are applicable. For Dates of Service 10/01/15 and beyond, providers must use the applicable ICD-10 diagnosis code that continues to reflect the intent and purpose of the Take Charge Plus program.

For questions, please contact Molina Medicaid Services at (800) 473-2783 or (225) 924-5040.

Attention Pharmacists of Louisiana Medicaid Fee for Service:

Effective October 1, 2015, FFS Medicaid will only accept ICD-10 diagnosis codes at POS in NCPDP field 424-DO (Diagnosis Code) and a diagnosis code qualifier of "02" must be submitted in NCPDP field 492-WE (Diagnosis Code Qualifier) to identify the ICD-10 code. Any prescription that requires a diagnosis code at Point of Sale and is filled, new or refill, with a date of service on or after October 1, 2015 must have a qualifier of "02" and an appropriate ICD-10 diagnosis code. Prescriptions filled before October 1, 2015 should have a qualifier of "01" and an appropriate ICD-9 diagnosis code, if required. Refer to http://www.lamedicaid.com/provweb1/Pharmacy/pharmacyindex.htm for more information.

Attention Pharmacists of Louisiana Medicaid Fee for Service (FFS):

Prescribing providers are encouraged to enroll in Fee for Service Medicaid as soon as possible. The Affordable Care Act (ACA) requires providers to be enrolled in FFS Medicaid when a Louisiana Medicaid claim is processed for payment involving that provider, either directly or indirectly. Directly would include claims paid to the provider, indirectly would include prescriptions, lab orders, referrals, etc. written by the provider. Prescribing providers should access enrollment forms at http://www.lamedicaid.com/provweb1/Provider_Enrollment/ProviderEnrollmentIndex.htm or call (225) 216-6370 with questions or concerns.

ATTENTION OB/GYN PROVIDERS:

Louisiana Medicaid has been in communication with the Office of Population Affairs (OPA) concerning the upcoming expiration date (October 31, 2015) on the current Sterilization Consent Form (HHS 687). OPA is in the process of requesting approval from Health and Human Services (HHS) for an extension of the current form as there are no planned revisions to the language used in the current form. Molina will continue to accept the current form until OPA publishes the form with an updated expiration date. Once the update occurs, an RA message will be published letting providers know how long the prior form will be accepted by Molina.

Please contact Molina Provider Relations (800) 473-2783 or (225) 924-5040 if you have any questions regarding this matter.

Attention Pharmacists of Louisiana Medicaid Fee for Service:

Molina is in the process of updating their system to accept the February 2013 version of the NCPDP paper claim form. The system will be ready within the next six weeks. Please NOTE that once the system is ready to receive the latest NCPDP form, a second notice will be sent to providers outlining a grace period for accepting any older versions of the paper pharmacy form. Billing information and a sample copy of the 02/2013 NCPDP form is available to view at http://www.lamedicaid.com/provweb1/billing_information/NCPDP_Billing_Instructions.pdf

ATTENTION GNOCHC PROVIDERS

For Demonstration Year 5 covering time period, 10/1/2014 - 9/30/2015, providers must submit claims for processing no later than 11/14/2015. Claims submitted after this date will not be approved. Claims must be postmarked no later than 11/14/15 if mailed or may be delivered directly to Molina as long as they are received no later than 5 p.m. on Friday, 11/13/15. For paper claim submissions, please use a 9 x 12 envelope marked on the outside in large letters, "GNOCHC Claims".