RA Messages for October 29, 2012

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 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 ALL OPTICAL SUPPLY SERVICE PROVIDERS RECYCLE OF OPTICAL SUPPLY SERVICES ASSOCIATED WITH RECIPIENTS ENROLLED IN A BAYOU HEALTH PREPAID PLAN

Recent updates have clarified that lenses and frames are NOT Carved Out from the scope of Bayou Health Prepaid plans. When these services are provided to a recipient enrolled in a Bayou Health Prepaid plan, the claim should be billed to the Bayou Health Prepaid plan claim, not Molina. These lenses and frame services include the following codes: S0580, V2020, V2025, V2100 through V2118, V2121, V2199 through V2221, V2299 through V2321, V2399, V2410, V2430, V2499 through V2503, V2510 through V2513, V2530, V2531, V2599, V2600, V2610, V2615, V2623 through V2632, V2700, V2702, V2710, V2715, V2718, V2730, V2744, V2745, V2750, V2755, V2756, V2760 through V2762, V2769, V2770, V2780 through V2788, V2797 and V2799. In order to reconcile your RA, please submit any of these claims to the Prepaid Bayou Health plan the recipient was enrolled with as of the date of service.

Claims for these services that were billed for recipients enrolled in a Bayou Health Prepaid plan as of the date of service and inappropriately paid were systematically voided on the checkwrite of September 25, 2012. If you have questions about claims submission or coverage, please contact the appropriate Pre-Paid Bayou Health plan.

ATTENTION PHARMACISTS

Effective immediately, Louisiana Medicaid will reimburse for Brand Name drugs at a Brand reimbursement when the Brand drug is on the PDL and the generic drug requires PA. To be reimbursed at a Brand, enter a value of �9,� which is Substitution Allowed by Prescriber but Plan Requests Brand; in the NCPDP field #408-D8. When �9� is entered in NCPDP field #408-D8, it will not be necessary for �Brand Medically Necessary� to be handwritten on the prescription by the prescriber. Please call the Pharmacy POS Helpdesk at 1-800-648-0790 for questions.

ATTENTION PHARMACISTS AND PRESCRIBING PROVIDERS

Louisiana Medicaid has updated RXPA forms. These forms are used when requesting Prior Authorization (PA) for drugs not on the Preferred Drug List (PDL) and forms used for reconsideration of a PA. These updated forms can be found at http://www.lamedicaid.com/provweb1/Pharmacy/rxpa/rxpaindex.htm. Please call the Pharmacy POS Helpdesk at 1-800-648-0790 for questions.

ATTENTION ALL EMT PROVIDERS BILLING ON PREPAID
BAYOU HEALTH PLAN RECIPIENTS FOR BEHAVIORAL HEALTH TRANSPORTATION

Emergency Medical Transportation services for recipients enrolled in a Prepaid Bayou Health Plan as of the date of service are considered Carved Out when associated with a Behavioral Health diagnosis (290
through 319.99). This clarification was implemented in processing effective for claims processed on or after August 9th, 2012. Any such transportation services for a recipient enrolled in a Bayou Health
Prepaid plan as of the date of service where a behavioral health diagnosis is present should be billed directly to Molina.

Claims submitted prior to August 9th, 2012, will be recycled and payment released on the October 30th, 2012 checkwrite to remediate claims that were incorrectly denied.