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.
Attention Professional Providers, Independent Laboratory Providers, Take Charge Plus Providers and Outpatient Hospital Providers
Effective with dates of service January 1, 2017 and forward, Louisiana Medicaid will no longer reimburse for routine cervical cancer screening for recipients under the age of 21 years.
However, Medicaid considers cervical cancer screening medically necessary for recipients under age 21who have the following conditions/diagnosis.
- Recipients who were exposed to diethylstilbestrol before birth
- Human immunodeficiency virus (HIV)
- A weakened immune system
- History of cervical cancer
- Other criteria subsequently published by ACOG.
- It is the responsibility of the treating provider to provide hard copy supporting documentation needed for billing purposes to the laboratory provider upon testing.
- Providers of these laboratory services must submit hard copy supporting documentation to the fiscal intermediary to have the age restriction bypassed for a specific clinical situation.
- Claims filed with hard copy supporting documentation to the fiscal intermediary will pend to Medical Review for confirmation of the conditions that are considered medically necessary.
- If the hard copy documentation is not present, the claim for the test will be denied.
- If the hard copy supporting documentation is present and meets the clinical criteria, the pend and age edits will be overridden and the claim will be released and processed as normal.
ATTENTION INSTITUTIONAL SERVICE PROVIDERS
LDH's TPL contractor, HMS, offers a web-enabled system, the Provider Portal, which
was designed specifically for providers to process disallowances on-line. The Provider
Portal offers many benefits such as immediate receipt of disallowance notifications,
elimination of paper listings, real-time access to disallowance projects, up-to-date claim
status, and on-demand reporting.
If you have not yet enrolled in the Provider Portal, we urge you to do so immediately by
contacting HMS Provider Relations at 877-259-3307 or by email at
HMSportalnotification@hms.com for enrollment and instruction assistance.
We encourage all providers to opt out of receiving paper listings in the future and only
use the Provider Portal for disallowance projects. The use of the Provider Portal will
ensure the protection of all PHI associated with these projects. Therefore, please advise
HMS Provider Relations if you are willing to opt out of receipt of paper listings.