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: Eligible Providers

Hurry! If you don’t begin participation in the Medicaid Electronic Health Records Incentive Program by December 31, 2016, you’ll miss out on $63,750 in incentive payments. Please visit the website at http://new.dhh.louisiana.gov/index.cfm/page/1159 for information. A new redesigned web portal will be ready for attestations starting September 19, 2016 at https://LAConnect.ThinkHTS.com. If you need additional information, please contact Kelli Douglas at 225-342-7742 or Gary Dillon at 225-342-4810.

Changes in Louisiana Medicaid Policy for ‘Transplant-Related’ Services

The Louisiana Department of Health (LDH) Medicaid policy concerning ‘transplant related’ services has changed. Effective with date of processing November 1, 2016, ‘transplant related’ services do not require an attached transplant prior authorization approval letter to be processed and paid. In the past, hospitals and physicians were required to attach the authorization letter to all transplant and transplant-related claims submitted to Molina for processing. This is no longer a requirement for ‘transplant related’ services.

This change does not impact claims for the actual organ transplant. All transplants must be authorized by the Prior Authorization Unit prior to the performance of the surgery. If the transplant is approved by the Prior Authorization Unit, the authorization letter is issued to the requesting hospital. When billing for the organ transplant, the hospital and all physicians involved must attach a copy of the approval letter and a dated operative report to the claims. As before, hospitals should share a copy of the transplant approval letter with all other providers involved in the patient’s transplant.