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 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.