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 EPSDT PROVIDERS

Louisiana Medicaid has updated the EPSDT Periodicity Schedule to closely align with the current American Academy of Pediatrics (AAP) Bright Futures "Recommendations for Preventive Pediatric Health Care" schedule (copyright 2008). Providers may download a PDF version at www.lamedicaid.com under the link for Training/2013 Policy Updates/Professional Services Program. The updated EPSDT Periodicity schedule is effective immediately.

Notable changes from the previous Louisiana Medicaid EPSDT periodicity schedule include:

  • The objective vision screening, procedure code 99173-EP, now begins at age three.

  • Preventive care services for adolescents are now expected to be performed annually. This change reflects the Department's goal to increase the number of annual preventive services in this age group and focus on adolescent health and improving health outcomes related to the adolescent population.

  • Please note that Louisiana Medicaid does not require the "3-5 day" visit listed currently on the "AAP website schedule." Those services are typically performed while the infant is in the hospital and are not required to be duplicated.

If you have any questions please contact Molina Provider Relations (800) 473-2783 or (225) 924-5040.

ATTENTION PROVIDERS OF INFLUENZA VACCINE

As part of the 2013 CPT update, a new influenza vaccine code, 90672 (Influenza virus vaccine....for intranasal use), was made available to providers on or after January 1, 2013. CPT code 90672 has been added to the Immunization fee schedule. Please note that procedure code 90672 can only be submitted with immunization administration codes 90473 or 90474. Medicaid will pay for the nasal administration of this vaccine. The vaccine code 90672 is to be submitted with a "zero" dollar amount as it is a part of the Vaccines for Children program provided at no cost to providers.

Molina has identified and recycled all claims for the new vaccine procedure code and the associated codes for the administration of the vaccine. These claims were recycled on the 11/05/13 RA and no action is needed by the providers.

If you have any questions please contact Molina Provider Relations (800) 473-2783 or (225) 924-5040.

ATTENTION PROVIDERS: NON-THIRD PARTY LIABILITY RELATED CREDIT BALANCE AUDITS

Clarification of Credit Balance Audits

Effective January 1, 2014, Myers and Stauffer, LC will assume the responsibility for performing non-TPL-related Credit Balance Audits (CBA) to identify excess Medicaid payments.

Please contact Myers and Stauffer at LA_RAC@mslc.com to set up a secure FTP account for submitting reports.