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 Louisiana Fee for Service (FFS) Medicaid Providers:

On December 27, 2018, Fee for Service (FFS) Medicaid implemented clinical pre-authorization requirements at Point of Sale (POS) for Growth Hormones, Cytokine and Cell-Adhesion (CAM) Molecule Antagonists, Lomitapide (Juxtapid®), Mipomersen (Kynamro®), Alirocumab (Praluent®), and Evolocumab (Repatha®). Please refer to www.lamedicaid.com for more information.

Attention Louisiana Medicaid Providers:

Effective January 1, 2019, Fee for Service (FFS) Medicaid and Managed Care Organizations (MCOs) will implement a diagnosis code exemption for sickle cell crisis for opioid prescriptions. Please refer to www.lamedicaid.com for more information.

Attention Obstetricians and Gynecologists

Louisiana Medicaid has been in communication with the Office of Population Affairs (OPA) concerning the upcoming expiration date (January 31, 2019) on the current Sterilization Consent Form (HHS 687). OPA is in the process of renewing the form, but will extend the expiration date of the current form one month at a time until final approval on the update form is received.

DXC Technologies will continue to accept the most current form until OPA publishes an updated form and expiration date. Providers are encouraged to check the OPA site directly for updates.

Once the update occurs, an RA message will be published letting providers know how long the prior form will be accepted by DXC Technologies.

Questions regarding this message and fee for service claims should be directed to DXC Technology Provider Relations at (800) 473-2783 or (225) 924-5040. Questions regarding managed care claims should be directed to the appropriate Managed Care Organization.

Attention FQHC and RHC Providers

Please be advised that Louisiana Department of Health (LDH) is retracting implementation of a separate payment for screening and diagnostic mammography for FQHC and RHC providers on 1/1/2019 as previously announced.

The Centers for Medicare and Medicaid (CMS) informed LDH on 1/15/19 that the request for the separate reimbursement for screening and diagnostic mammography for FQHC and RHC providers was not approved.

Please contact Irma Gauthier at Irma.Gauthier2@la.gov with questions regarding this message.

Attention Louisiana Fee for Service (FFS) Medicaid Providers:

On January 9, 2019, Fee for Service (FFS) Medicaid and Managed Care Organizations (MCOs) implemented diagnosis code requirements, maximum daily dose, and quantity limits at Point of Sale (POS) for aripiprazole (Aristada®) and risperidone (Perseris®). Please refer to www.lamedicaid.com for more information.

Attention Louisiana Fee for Service (FFS) Medicaid Providers:

On January 9, 2019, Fee for Service (FFS) Medicaid and Managed Care Organizations (MCOs) implemented Point of Sale (POS) edits for pimavanserin (Nuplazid®). Please refer to www.lamedicaid.com for more information.