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 PROVIDERS REMINDER
On August 11, 2014, Molina systemically voided all
identified paid claims for legacy and shared plan recipients associated with the
retroactive enrollment or dis-enrollment of Bayou Health members and plan
linkages from February 1, 2012 through June 30, 2014. These voids appeared on
RAs with edit 999, Administrative Correction.
A Remittance Advice message ran from July 29, 2014 through August 12, 2014 and a
web notice was posted on August 8, 2014 notifying providers that DHH would void
all paid claims.
The 6 month deadline to resubmit these voided claims is
February 11, 2015.
We are reminding providers that this deadline is
All claims and required documentation must be resubmitted
to the correct entity by that date in order to be considered for payment.
Providers should refer to the web notice (08/06/14) or RA messages mentioned
above for detailed directions on how to resubmit these claims.
If you have any additional questions or concerns, please contact Darlene White
at (225)342-5924 or Darlene.White@la.gov
ATTENTION ALL PROVIDERS
CHANGES IN POST OFFICE BOXES FOR SUBMISSION OF PAPER CLAIMS
EFFECTIVE FEBRUARY 1, 2015
Effective February 1, 2015, Molina will be consolidating
several Post Office boxes and providers should begin sending claims to the newly
Below is a list of the Post Office boxes currently used
(indicated as Old Box Number) and a list of the corresponding 'New' box assigned
for that claim type (indicated as New Box Number).
this information with your staff and make the necessary changes in your internal
procedures to begin sending your paper claims to the new box immediately.
Old Box Number
New Box Number
(All Medicare Crossovers)
Program ended 2012; claims may no longer be submitted.
For questions related to this information, please contact
Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.
Thank you for your assistance in this matter.
ATTENTION ALL PROVIDERS 2015 HCPCS UPDATE
Louisiana Medicaid is currently in the process of completing the 2015 HCPCS update. The Louisiana Medicaid files
have been updated to reflect the deleted HCPCS codes for 2015. It is the Department's intent to have the new 2015
codes and updates on file as soon as possible including the appropriate editing and coverage determination for the
new 2015 HCPCS codes. Providers should submit claims for the appropriate HCPCS code to preserve timely filing.
Claims denied due to use of the new 2015 HCPCS codes not on file yet, will be recycled once the fee schedule
updates are complete.
The Professional Services Fee Schedule and Outpatient Hospital Fee Schedule on the Louisiana Medicaid website,
will be updated in the near future to reflect coverage of the new 2015 codes. Providers should monitor
their RA messages for additional information.
Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and
Effective January 21, 2015, clinical pre-authorization will be required on pharmacy
claims for ADHD/ADD medication prescriptions for recipients <48 months old. Please
TO ALL DME PROVIDERS
Effective December 15, 2014, portable oxygen equipment will be reimbursed for members who need continuous oxygen and require portable units while en route to a doctor's office, hospital or medically necessary appointment. Documentation of medical necessity as well as the anticipated number of visits per month needed must be submitted by the member's treating physician with the prior authorization request. Portable systems will not be approved to be used on a standby basis only. Units will be authorized per month based on review of submitted medical justification. An example of justification for refills includes, but is not limited to, multiple weekly visits for radiation or for chemotherapy. For recipients under age 21 only, portable oxygen may be approved when needed for travel to and from school.
All requests for portable oxygen should be submitted using the following procedure codes:
E0430-07 - Portable gaseous oxygen system (rental -includes regulator, flow meter, humidifier, cannula or mask, and tubing)
E0430-09 - Portable gaseous oxygen system (purchase - includes regulator, flow meter, humidifier, cannula or mask, and tubing)
E0443-09 - Portable oxygen contents, gaseous, l month's supply = 1 unit
ATTENTION HOSPITAL AND PROFESSIONAL PROVIDERS OF INPATIENT SERVICES:
Effective with date of processing February 1, 2015, precertification of inpatient hospital services for Fee for Service Medicaid recipients will no longer be required. Hospital claims for inpatient services will no longer require a precertification number for payment. Professional claims for inpatient services will pay without the requirement of an inpatient precertification on file with the fiscal intermediary.
Each day of an inpatient stay must be medically necessary. All claims for inpatient services are subject to post payment medical necessity review and recoupment if medical necessity is not met.
Please note that these changes to precertification requirements are for Fee for Service recipients only. Both shared and prepaid Bayou Health Plans will continue to require precertification of inpatient hospital stays for their members.
Please view the web post at LaMedicaid.com for complete details.
Attention ALL Louisiana Medicaid Providers:
Effective February 1, 2015, all claims must be filled within 180 days from
the date of service with some exceptions. Exceptions include:
- Hospital lnpatient claims must be filed within 180 days from the date of
- Claims for members who have Medicare and Medicaid coverage must follow
Medicare timely filing guidelines and submit to Medicaid within 180 days from
- Claims for Retroactive Medicaid members must be filed within 180 days
from eligibility determination.
- Adjustments and Voids must be filed within 180 days from Date of Payment.
- Services billed to and reimbursed by Magellan
This will be effective February 1, 2015. Claims with a date of service and/or
date of discharge through January 31, 2015 will follow the 365 day timely
filing guidelines. Claims with date of service and/or date of discharge
of February 1, 2015 or later will follow the new timely filing guidelines,
Your continued cooperation and support of the Louisiana Medicaid Program
efforts to coordinate care and improve health are greatly appreciated.
If you have questions about the contents of this memo, you may contact Molina
Provider Relations at (800) 473-2783 or refer to