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

Molina is experiencing greater volumes of hard copy claims in which providers use of liquid paper for corrections is causing the pages of the claims to stick together. This practice creates two problems:

(1) The pages are not readable after being pulled apart; and

(2) Pages that are stuck together cause scanning equipment to jam.

Therefore, we request that providers not use liquid correction products to make corrections on claims. Please use either a 'tape-type' product or mark through the error and rewrite the corrected information. All information on the claim form must be clear and readable in order for the claim to be processed correctly.

ATTENTION ALL PROVIDERS SUBMITTING FEE FOR SERVICE
LOUISIANA MEDICAID CLAIMS TO MOLINA

Louisiana Medicaid's 7-digit provider number is required on all claim forms. Each week, Molina rejects and returns paper claims because the 7-digit Louisiana Medicaid provider number is not present on the claim form in the appropriate field. Providers must be enrolled in Louisiana Medicaid and receive a 7-digit provider number in order to bill services to Louisiana Medicaid. If you are an enrolled provider, please ensure the Louisiana Medicaid Provider number is on the claims before mailing. If you are a provider not enrolled in Louisiana Medicaid (whether in-or out-of-state) and you have provided services to a Louisiana Medicaid recipient, you must enroll as a Louisiana Medicaid provider in order to be reimbursed for services rendered.

ATTENTION ALL PROVIDERS
RESUBMISSION OF PAPER CLAIMS TO MOLINA FOR BAYOU HEALTH
SHARED PLAN (UHC OR CHS) MEMBERS

Shared Plan claims received by Molina after the initial one year timely filing limit cannot be processed unless the provider is able to furnish the Shared Plans EOB or Payment Register showing the original claim was filed timely. Molina has received Shared Plan claims where only the private insurance EOB is attached and no Shared Plan EOB or Molina EOB is present. A private insurance EOB does not support proof of timely filing with Medicaid. All outstanding claims over 1 year old must be submitted with either the Shared Plan or Molina EOB indicating proof of timely filing. If a situation involves private insurance, that TPL EOB must also be submitted with the claim, however, it does not replace the EOB required from either the Shared Plan or Molina in providing proof of filing.

ATTENTION PROVIDERS AND SUBMITTERS OF ELECTRONIC CLAIMS

The deadline for receiving the 2016 Annual Certification Forms is December 31, 2015. If you have not submitted a Certification Form for your submitter number (beginning with 450), immediate action is required. Submitters who do not submit the required form will be deactivated February 1, 2016. Providers should verify with their submitter that this requirement has been met to ensure no delays in claims payment.

Submitters must mail the Annual Certification Forms to Molina at the following address:

Molina Medicaid Solutions - EDI Department
PO Box 91025
Baton Rouge, LA 70821-9025

The form can be found here: 2016 EDI Certification Form.

ATTENTION PROFESSIONAL OBSTETRICAL AND HOSPITAL PROVIDERS
Medicaid Coverage of Delivery Services Provided in Free Standing Birthing Centers:

Free Standing Birthing Centers (FSBC’s) are now eligible for enrollment in Medicaid for the provision of vaginal delivery services. Facility enrollment packets and the FSBC provider manual are available online at http://www.lamedicaid.com. Facility criteria for enrollment, program policy, and facility billing instructions are outlined in the provider manual.

Retrospective enrollment of FSBC’s will not be authorized. The enrollment process must be complete prior to the provision of services. Services provided on dates of service prior to the effective date of enrollment are not eligible for reimbursement.

Please contact Molina Provider Relations (800) 473-2783 or (225) 924-5040 if you have any questions regarding this matter.

ATTENTION PROFESSIONAL PROVIDERS
LICENSED MIDWIVES NOW ELIGIBLE TO ENROLL AS MEDICAID PROVIDERS:

Licensed Midwives are now a recognized provider type under Louisiana Medicaid. To be eligible for enrollment, Licensed Midwives must be certified by the North American Registry of Midwives (NARM) and posess a current, unencumbered license from the Louisiana State Board of Medical Examiners (LSBME).

Retrospective enrollment of Licensed Midwives will not be authorized. The enrollment process must be complete prior to the provision of services. Services provided on dates of service prior to the effective date of enrollment are not eligible for reimbursement.

Covered vaginal delivery services are eligible for reimbursement only when provided at a Medicaid enrolled Free Standing Birthing Center (FSBC). Services provided at locations other than Medicaid enrolled FSBC’s are not covered.

Please contact Molina Provider Relations (800) 473-2783 or (225) 924-5040 if you have any questions regarding this matter.

ATTENTION TAKE CHARGE PLUS PROVIDERS
RECYCLE OF CLAIMS DENIED IN ERROR DUE TO DIAGNOSIS CODING ISSUES

It was brought to our attention that some Take Charge Plus claims for dates of service beginning 10/1/15 denied for diagnosis code errors when a correct ICD-10 diagnosis code was presented on the claims. The issue with the ICD-10 code table has been corrected and impacted claims will be systematically recycled on the 12/22/2015 Remittance Advice (RA). No action is required by providers and we apologize for any inconvenience this has caused.

ATTENTION PCS PROVIDERS

It has come to our attention that some PCS claims with dates of service 12-1-2015 forward have denied in error for edit 507 (submit claims to BYU health plan). The error has been corrected and these denied claims will be recycled on the 12-22-2015 RA. No action is required by providers and we apologize for the inconvenience this may have caused.

Should you have questions related to the voids, please contact Molina Providers Relations at 1-800-473-2783. Questions regarding submission of claims to/payment by the correct entity should be directed to the MCO.