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: ICF/IID FACILITIES

The USC, CFR, and La Medicaid State Plan require that the claim, defined as a single document line identifying the services and/or charges for services for a single recipient from a single provider, be submitted to Louisiana Medicaid for payment within 12 months from the date of service and that the claim be paid no later than 12 months from the date of receipt of the claim. Failure to bill within the allotted period will result in the nonpayment of claims.

In addition, the Louisiana Department of Health strongly encourages providers to bill monthly and to attempt to clear any denials received within two billing periods.

ATTENTION PROVIDERS OF HOME HEALTH SERVICES

Louisiana Medicaid has implemented changes required by The Centers for Medicare and Medicaid Services (CMS) in accordance with 42 CFR 440.70 for home health services, and in line with Medicaid State Plan updates.

Effective December 1, 2018 Louisiana Medicaid Fee for Service beneficiaries aged 21 and over will now require Prior Authorization (PA) for skilled nursing and home health aide services.

For further in formation see web notice title “ATTENTION PROVIDERS OF HOME HEALTH SERVICES” located on www.lamedicaid.com.

PHYSICIAN REQUIREMENTS FOR ORDERING HOME HEALTH SERVICES

The Centers for Medicare and Medicaid Services (CMS) requires a face-to-face encounter between a beneficiary and their certifying physician, or an allowed non-physician practitioner, to occur no sooner than 90 days prior to the start of home health services, or no later than 30 days after the start of home health services.

It is the responsibility of the home health agency to acquire the face-to-face encounter documentation and submit it to Molina, as soon as possible for both emergent and non-emergent home health services requests.

For further information see web notice title “PHYSICIAN REQUIREMENTS FOR ORDERING HOME HEALTH SERVICES” located on www.lamedicaid.com.

Attention Non-Physician Providers

Louisiana Medicaid has adjusted its reimbursement methodology for Non-Physician Provider physician administered injections, long acting reversible contraceptives, immunizations and EPSDT preventive services, in view of system errors found.

Affected providers will therefore see this reflected in recycled claims on the remittance advice of November 27, 2018, for dates of service from January 1, 2017 to current.

Questions regarding this message and fee-for-service claims should be directed to Molina Provider Relations at (800) 473-2783 or (225) 924-5040.

Questions related to managed care claims should be directed to the appropriate Managed Care Organization (MCO).

Attention All Immunization Providers
Coverage of Hepatitis B Adult 2 Dose Vaccine

Effective with dates of service on and after November 1, 2018, Louisiana Medicaid covers Hepatitis B adult 2 dose vaccine. The billable CPT code is 90739.

Note: There will be no changes to the Hepatitis B adult 3 dose vaccine.

Questions regarding this message and fee for service claims should be directed to Molina Provider Relations at (800) 473-2783 or (225) 924-5040. Providers may resubmit any improperly denied claims based on the effective for a date of service on or after November 1, 2018.

Updates to Healthy Louisiana related policy, systems and claims processing changes are plan specific and are the responsibility of each managed care organization. For questions regarding Healthy Louisiana updates and prior authorization requirements, please contact the appropriate managed care organization.

Attention Louisiana Medicaid Providers:

Effective December 12, 2018, the Louisiana Medicaid Fee for Service (FFS) Pharmacy Program will implement Point of Sale (POS) quantity limits and duration of therapy edits on anticoagulant medications. Please refer to www.lamedicaid.com for more information.

Attention Louisiana Medicaid Providers:

Effective December 12, 2018, the Louisiana Medicaid Fee for Service (FFS) Pharmacy Program will remove the new prescription requirement for each filling of a buprenorphine agent. Also, an incoming pharmacy claim for a benzodiazepine will not deny for concurrent use of benzodiazepines and opiates if an acceptable seizure diagnosis code is entered at Point of Sale (POS). Please refer to www.lamedicaid.com for more information.