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.


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 pharmacy providers.

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

Attention Pharmacists and Prescribing Providers:

A new clinical pre-authorization form will be available to request certain specialty drugs. Effective March 25, 2014 clinical pre-authorization will be required for Zyvox (linezolid), Granix (tbo-filgrastim), Leukine (sargramostim), Neulasta (pegfilgrastim), and Neupogen (filgrastim). The new form will be available at

2014 Assistant Surgeon and Assistant at Surgery Procedure Codes

Each year DHH publishes a list of allowed procedures for assistant surgeons and assistant at surgery based on updates made by the McKesson Corporation to their 'ClaimCheck' product. McKesson uses the American College of Surgeons (ACS) as its primary source for determining assistant surgery designations.

The updated list titled, "2014 Assistant Surgeon and Assistant at Surgery Procedure Codes" has been posted to the LA Medicaid website ( under the ClaimCheck icon.

This list does not ensure payment but provides a comprehensive list of codes that may be allowed when billed by an assistant surgeon or by an assistant at surgery.

For questions related to this information as it pertains to legacy Medicaid or Bayou Health Shared Savings Plans, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.

Attention Take Charge Program Providers

This notice is in follow up to a previous message posted on February 11, 2014 in regards to a reimbursement rate adjustment made on certain procedure codes under the Take Charge Waiver. For those procedure codes billed on claims submitted after January 6, 2014, a recycle will take place and be reflected on the check-write scheduled for March 18, 2014.