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 Durable Medical Equipment Providers
Effective April 1, 2019, and with date of service forward, Louisiana Medicaid will require an attestation for breast pump coverage. All DME providers will be required to obtain the Electric Breast Pump Request Form signed by the patient at the point of sale.
The Electric Breast Pump Attestation form will be located on www.lamedicaid.com under forms, files and user manuals. It will be included in the DMEPOS provider manual as Appendix I, as well. DME providers should submit the completed form with the claim for medical review.
In addition to the attestation form, Louisiana Medicaid will publish specific equipment criteria guidelines for electric breast pumps in the DMEPOS provider manual on www.lamedicaid.com.
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.
2019 HCPCS and Physician-Administered Drug Reimbursement Updates
The Louisiana Medicaid fee-for-service (FFS) files have been updated to reflect the new and deleted Healthcare Common Procedure Coding System (HCPCS) codes effective for dates of service on or after January 1, 2019. Providers will begin to see these changes on the remittance advice of February 5, 2019. Claims that have been denied due to use of the new 2019 codes prior to their addition to the claims processing system will be systematically recycled with no action required by providers.
Effective for dates of service beginning on January 1, 2019, Louisiana Medicaid updated the reimbursement rates on the FFS file for physician-administered drugs and payable vaccines in the physician office setting to align with the Medicare 2019 Average Sale Price (ASP) drug rate or wholesale acquisition cost. Claims previously submitted for these drugs or vaccines with dates of service on or after January 1, 2019 will be systematically adjusted to ensure proper payment. No action is required by the provider.
For questions related to this information as it pertains to fee-for-service Medicaid claims processing, please contact DXC Technology Provider Services at (800) 473-2783 or (225) 924-5040.
Please contact the appropriate Managed Care Organization with any questions concerning their 2019 HCPCS updates.