PHARMACY PROVIDERS, PLEASE NOTE!!!

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.

2019 Allowed Procedures for Assistant Surgeon and Assistant at Surgery Providers

Louisiana Medicaid has published the 2019 fee for service list of allowed procedures for assistant surgeon and assistant at surgery providers. The list titled, “2019 Assistant Surgeon and Assistant at Surgery List of Covered Procedures” has been posted to the LA Medicaid website (www.lamedicaid.com) under the ClaimCheck icon.

The changes are based on updates made by the Change Healthcare to their ‘ClaimCheck’ product. Change Healthcare uses the American College of Surgeons as its primary source for determining assistant surgery designations.

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 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.

Attention Physicians and Independent Laboratories
2019 Clinical Laboratory Services - Reimbursement Changes

Under Federal regulation, state Medicaid agencies are prohibited from reimbursing providers of clinical laboratory services at a higher rate than the Medicare allowable rate. In accordance with this regulation, clinical laboratory reimbursement rates have been updated on the fee-for-service Medicaid file effective for dates of service January 1, 2019 and forward. The Laboratory and Radiology fee schedule has been updated to reflect those changes.

Clinical laboratory claims for dates of service on or after January 1, 2019, where the previous reimbursement exceeded the Louisiana Medicare allowable rate will be systematically recycled on the remittance of March 19, 2019 without any action required by the provider.

Please contact DXC Technology Provider Relations at (800) 473-2783 or (225) 924-5040 if there are questions related to this matter for fee for service claims.

Questions related to the Healthy Louisiana managed care organizations' updates should be directed to the specific health plan.