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: 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.
2018 HCPCS Claims Recycle
Louisiana Medicaid fee-for-service (FFS) claims, processed from January 1, 2018 through January 30, 2018 that were denied due to use of the new 2018 procedure codes prior to their addition to the claims processing system will be recycled. Providers can expect to see the recycled claim results on the remittance advice of February 27, 2018. No action is required by providers. (This does not include outpatient hospital claims which will be handled separately.)
Please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040 if there are questions related to this matter for FFS service claims. Questions related to the Healthy Louisiana managed care organizations' updates should be directed to the specific health plan.