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.
PAYMENT ERROR RATE MEASUREMENT (PERM) 2017 IS NOW IN PROGRESS
Louisiana Medicaid is mandated to participate in the Centers for Medicare and Medicaid (CMS) Payment Error Rate Measurement (PERM) program which will assess our payment accuracy rate for the Medicaid and CHIP programs. If chosen in a random sample, your organization will soon receive a Medical Records Request from the CMS review contractor, CNI Advantage.
Please be advised that sampled providers who fail to cooperate with the CMS contractor by established deadlines may be subject to sanctioning by Louisiana Medicaid Program Integrity through the imposition of a payment recovery by means of a withholding of payment until the overpayment is satisfied, and/or a fine.
Please be reminded that providers who are no longer doing business with Louisiana Medicaid are obligated to retain recipient records for 5 years, under the terms of the Provider Enrollment Agreement.
For more information about PERM and your role as a provider, please visit the Provider link on the CMS PERM website: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/PERM/Providers.html.
ATTENTION: Providers and Submitters of Fee for Service (FFS) Medicare Crossover Claim Denials for Dual QMB/Take Charge Plus Members
Medicaid will cover Take Charge Plus related services when a member has dual Take Charge Plus and QMB eligibility. However, if the claim is submitted as a crossover claim and the services were denied by Medicare, they will be denied by Medicaid. In these instances, the claim should be resubmitted to Molina hard copy with the Medicare EOB attached documenting Medicare’s denial. Molina will review and special handle these claims to bypass the appropriate edits for processing.
2018 Update to ‘ClaimCheck’ Product Editing
Change Healthcare, formerly the McKesson Corporation, routinely updates their ‘ClaimCheck’ product based on changes made to the resources used, such as Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) coding guidelines, the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule Database, CMS National Correct Coding Initiative (NCCI) and/or provider specialty society updates. The ‘ClaimCheck’ product’s procedure code edits are guided by these widely accepted industry standards.
The edit changes related to the 2018 HCPCS update went into effect for claims processed beginning with the remittance advice of January 30, 2018. Providers can expect that most claims will continue to edit in the same manner, but based on these updates, some claims could pay or deny for a different reason.
Please contact the appropriate Managed Care Organization with any questions regarding their updates. For questions related to this information as it pertains to fee-for-service Medicaid claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.
ATTENTION: LTC and ICF-DD FACILITIES
Beginning April 2018, monthly Optional State Supplement (OSS) payments will be generated by State of Louisiana Division of Administration.
To receive OSS payments for eligible residents of Long Term Care and ICF-DD Facilities after March 2018, the Facility must complete one of the following registration processes:
- Assisted Registration
Complete the OSS Provider Registration Workbook posted on LaMedicaid.com on the Online Forms or Files section (OSS Provider Registration Workbook)
Vendors must also submit the ISIS EFT FORM which may be downloaded here: http://www.doa.la.gov/osrap/ISIS EFT Form.pdf.
Submit the completed workbook, EFT form, and associated IRS W-9 by email to OSS@la.gov no later than February 16, 2018.
- Register the Facility with Louisiana Division of Administration @ http://www.doa.la.gov/pages/osp/vendorcenter/vendorregn.aspx
- Submit a completed IRS W-9 form for the Facility to DOA-OSRAP, via e-mail at DOA-OSRAP-LAGOV@LA.GOV or fax (225) 342-0960.
- Vendors must also submit the ISIS EFT FORM which may be downloaded here: http://www.doa.la.gov/osrap/ISIS EFT Form.pdf.
If you have questions or need assistance with workbook completion or LAGOV registration, you may contact us by email at OSS@la.gov or by phone: (225) 342 – 0456 (Lorie), (337) 447 – 4145 (Shauna), or (225) 342 – 0441 (Kate).
Providers must continue to review the OSS Payment Remittances through the OSS web application in order to verify and issue individual recipient payments.
Return Payments must be made through the OSS system. Payments should not be returned to Louisiana Department of Health.
Refer to the OSS Provider User Guide located on the “Forms/Files/Surveys/User Manuals” tab at LaMedicaid.com for additional information.