PHARMACY PROVIDERS, PLEASE
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
Should you have any questions
regarding any of the following messages, please contact Molina Medicaid
Solutions at (800) 473-2783 or (225) 924-5040.
PAYMENT ERROR RATE MEASUREMENT (PERM) 2017 IS NOW IN PROGRESS
Louisiana Medicaid is mandated to participate in the Centers for Medicare and Medicaid (CMS) Payment Error Rate Measurement (PERM) program which will assess our payment accuracy rate for the Medicaid and CHIP programs. If chosen in a random sample, your organization will soon receive a Medical Records Request from the CMS review contractor, CNI Advantage.
Please be advised that sampled providers who fail to cooperate with the CMS contractor by established deadlines may be subject to sanctioning by Louisiana Medicaid Program Integrity through the imposition of a payment recovery by means of a withholding of payment until the overpayment is satisfied, and/or a fine.
Please be reminded that providers who are no longer doing business with Louisiana Medicaid are obligated to retain recipient records for 5 years, under the terms of the Provider Enrollment Agreement.
For more information about PERM and your role as a provider, please visit the Provider link on the CMS PERM website: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/PERM/Providers.html.
ATTENTION: LTC and ICF-DD FACILITIES
UPDATE: Beginning with the March 2018, monthly Optional State Supplement (OSS) payments will be generated by State of Louisiana Division of Administration.
To receive OSS payments for eligible residents of Long Term Care and ICF-DD Facilities after February 2018, the Facility must complete the following no later than January 12, 2018:
- Register the Facility with Louisiana Division of Administration @ http://www.doa.la.gov/pages/osp/vendorcenter/vendorregn.aspx
- Submit a completed IRS W-9 form for the Facility to DOA-OSRAP, via e-mail at DOA-OSRAP-LAGOV@LA.GOV or fax (225) 342-0960.
- Vendors requesting EFT Payments must register at the following ISIS EFT FORM link @ http://www.doa.la.gov/osrap/ISIS EFT Form.pdf.
If you need help with LAGOV registration, contact Office of State Procurement via email VENDR_INQ@la.gov or phone 225-342-8010.
Providers must continue to review the OSS Payment Remittances through the OSS web application in order to verify and issue individual recipient payments.
Return Payments must be made through the OSS system. Payments should not be returned to Louisiana Department of Health.
Refer to the OSS Provider User Guide located on the “Forms/Files/Surveys/User Manuals” tab at LaMedicaid.com for additional information.
For questions related to this announcement, email to OSS@la.gov; or contact LDH’s OSS Program Manager, Lorie Young, by phone at (225) 342-0456.
ATTENTION ALL PROVIDERS - 2018 HCPCS UPDATE
Louisiana Medicaid is currently in the process of completing the 2018 Healthcare Common Procedure Coding System (HCPCS) update. Part of the update includes changing Louisiana Medicaid files to reflect the deleted HCPCS codes for 2018. It is the intent to have the new 2018 codes and updates on file as soon as possible including the appropriate editing and coverage determination for the new 2018 HCPCS codes.
Providers should submit claims for the appropriate HCPCS code to preserve timely filing. Claims denied due to the use of the new 2018 HCPCS codes not on file as of January 1, 2018, will be recycled once the fee schedule updates are complete.
Applicable Fee Schedules on the Louisiana Medicaid website, www.lamedicaid.com, will be updated in the near future to reflect coverage of the new 2018 codes. Providers should monitor their RA messages for additional information.
Please contact the appropriate Managed Care Organization with any questions concerning their 2018 HCPCS updates. For questions related to this information as it pertains to fee-for-service Medicaid claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.