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 ALL MANAGED CARE ENTITIES
END-OF-TIME DATE CONVERSION FROM 12/31/2020 TO 12/31/2050

LDH Medicaid and DXC would like to announce that file end-of time dates will be converting from 12/31/2020 to 12/31/2050. DXC will convert end-of-time date on recipient eligibility and TPL data. DXC is working with Maximus to test these changes in their processes, including the 834 file process. DXC will alter the TPL file to use an end-of-time date of 12/31/2050 and will send test files to the plans. For Provider registry, DXC will convert 12/31/2020 to 12/31/2050 as an end-of-time date and will test with the plans.

If there are any questions regarding this message, please contact DXC Provider Relations at (800) 473-2783.

Attention All EPSDT PCS Providers

Electronic Visit Verification for Early and Periodic Screening, Diagnosis and Treatment Personal Care Services

The Louisiana Department of Health (LDH) is implementing an electronic visit verification (EVV) system for providers of Early and Periodic Screening, Diagnosis and Treatment (EPSDT) personal care services (PCS). This is a federal requirement that applies to all managed care EPSDT PCS providers.

EVV is a web-based system that electronically verifies service visit occurrences and documents the precise time services begin and end via smart devices. The purpose of an EVV system is to verify that individuals are receiving the services authorized in their plans of care, reduce inappropriate billing/payment, safeguard against fraud and improve program oversight. The implementation date will be Jan. 1, 2020.

Agencies shall use the EVV system designed by LDH, the Louisiana Service Reporting System (LaSRS), to electronically report begin and end times (i.e. clock-in and clock-out) for EPSDT PCS. Providers will have access to this system at no cost and should schedule training for the EVV system through the Department’s EVV contractor, Statistical Resources Inc. Providers may call (225) 767-0501 to schedule training.

Managed care organizations or LDH may withhold or deny reimbursement for services if an EPSDT PCS provider fails to use the EVV system.

Attention Providers of Laboratory Services
Severe Combined Immunodeficiency (SCID) Testing

Effective for dates of service on or after Nov. 1, 2019, Louisiana Medicaid will cover testing for Severe Combined Immunodeficiency (SCID). This will be part of the required newborn screening and will as such follow the newborn screening restrictions as indicated in policy. This test will be reimbursable under the CPT code 81479. This code is only to be used for this purpose and until such a time as a permanent procedure code is in place.

Questions regarding this message and fee for service claims should be directed to DXC Technology Provider Relations at (800) 473-2783 or (225) 924-5040. Questions regarding managed care claims should be directed to the appropriate Managed Care Organization.