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 Gainwell Technologies 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 Durable Medical Equipment (DME) Providers
Louisiana Medicaid will implement system edits to ensure that the
ordering and rendering providers for claim type 09 enroll in
Louisiana Medicaid as individual practitioners and not as a group
or clinic. A group or clinic must not be listed as the ordering or
referring provider on claims or encounters. This includes, for
example, ordering and referring provider types 70, 72, 79, 87, and
95.
Edit (047) will be educational for 30 days from the date of the pending informational
bulletin. The edit will then be set to deny claims and encounters with a group or
clinic NPI listed as the ordering or referring provider.
Each managed care organization (MCO) shall update its claims processing system to
reflect this change within 30 calendar days of the published update.
For questions related to this information as it pertains to fee-for-service Medicaid
claims processing, please contact Gainwell Technologies Provider Services at (800)
473-2783 or (225) 924-5040.
Questions regarding MCO claims should be directed to the appropriate MCO.