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 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 PROFESSIONAL SERVICES PROVIDERS:
It has been brought to the Department's attention that code J1050, Medroxyprogesterone
Acetate was inadvertently added to the Medicaid procedure file in 2013 without the
appropriate budgetary reduction to the fee. This reimbursement amount has been corrected
and the Professional Services Fee Schedule has been updated. All impacted claims will be
recycled for potential recoupment and/or adjustments of funds on the RA of
February 25, 2014. No action is required by providers.
For questions related to this recycle, please contact Molina Medicaid Provider Services at
(800) 473-2783 or (225) 924-5040.
TO ALL DME PROVIDERS
Effective March 1, 2014, all prior authorization requests for standing frames should be
submitted using the standing frame criteria and form. This criterion has been updated in
the DME provider manual and the standing frame form is labeled Appendix G. All standing
frame requests submitted without the standing frame form will be denied.
Attention Pharmacists and Prescribing Providers
On the RA of January 28th some pharmacy claims were voided by providers through
POS. On the RA of February 4th, these same claims were systematically voided again in
error. We have generated manual pharmacy claims to offset the erroneous duplicate voids
and these claims will appear on the March 4th RA. The ICN range of these manual claims is
4054888800001 to 4054888812908. We apologize for any inconvenience this may have caused
Attention Pharmacists and Prescribing Providers:
Diagnosis codes will be required on pharmacy claims for select specialty drugs. Please
refer to the website for the complete list with appropriate diagnosis codes. These new
edits will be effective March 12, 2014. See www.lamedicaid.com.