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 ALL PROVIDERS

The diagnosis code 3051 (Tobacco Use Disorder) will be paid under Medicaid Managed Care (Bayou Health) for health plan recipients and by Molina for legacy Medicaid recipients. This diagnosis is not paid under LBHP through Magellan. Claims will be recycled on the 11/22/13 RA.

Please submit claims with a primary diagnosis of 3051 to the appropriate Bayou Health Plan or Molina for processing. Please refer to the Informational Bulletin 12-18 at www.makingmedicaidbetter.com for the complete list of behavioral health Diagnosis Codes that are excluded from payment by Magellan.

ATTENTION PCS PROVIDERS
CLAIMS DENIED IN ERROR DUE TO PREPARATION FOR CHANGES IN SERVICE LIMITS

In preparation for service limit changes for LT-PCS, logic was altered prior to notifying providers of these changes. Starting with the RA of 10/8/13, claims processed for LT-PCS services for T1019 UB, T1019 UN, and T1019 UP with daily units greater than 32 and less than 47 denied with edit 542 (units exceed maximum daily allowed limit). This logic change is being reversed to put the educational edit 543 (units paid between 33 and 47) back in place temporarily and denied claims are being recycled. No action is required by providers. Please monitor RA messages and the web site for additional upcoming information concerning these service limit changes.

For questions related to this notification, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.

Revised status on LTC/ICF-DD Adjustments and Voids scheduled for the 10/29/2013 checkwrite

Molina generated adjustments and voids originally scheduled for processing for the October 29, 2013 have been re-scheduled for processing on the November 5th, 2013 checkwrite. Please be aware that this in no way delays or defers the processing of provider-submitted adjustments/voids on payments. For questions or concerns regarding this notification, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.

NCCI Changes to Preventive Care/Immunization Administration Billing Effective January 2014

Effective January 2014, there are changes to CMS's National Correct Coding Initiative (NCCI) billing guidance: Providers are directed to the Louisiana Medicaid homepage, (www.lamedicaid.com/) for details on new CMS directives when billing for preventive care and immunization administration codes on the same date of service.