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 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.

Attention Obstetricians and Providers of Prenatal and Laboratory Services

Effective for dates of service on or after February 1, 2019, Louisiana Medicaid will cover Non Invasive Prenatal Testing (NIPT) for the detection of fetal chromosomal abnormalities in pregnant women.

This test will be offered as a service to pregnant women over the age of 35, and for women of all ages meeting specified high-risk criteria.

This service is subject to medical review. Providers must submit all required documentation to support the documented high-risk criteria along with a hard copy claim to the department’s fiscal intermediary. Failure to provide the required documentation, or if the documentation submitted fails to meet the above listed criteria, will result in denial of payment for this service.

Information regarding this policy is forthcoming and will be found on www.lamedicaid.com under the Provider Manuals link, within the Professional Services manual.

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 Louisiana Medicaid Providers:

On December 19, 2018, the Louisiana Medicaid Fee for Service (FFS) Pharmacy Program implemented Point of Sale (POS) edits for incretin mimetic/enhancers for maximum daily dose limits and prior use of metformin required. Please refer to www.lamedicaid.com for more information.

Attention Louisiana Medicaid Providers:

On December 19, 2018, the Louisiana Medicaid Fee for Service (FFS) Pharmacy Program implemented Point of Sale (POS) edits with prior use of metformin required for Sodium Glucose Co-Transporter 2 Inhibitors. Please refer to www.lamedicaid.com for more information.