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.

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 www.lamedicaid.com.

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 (www.lamedicaid.com) 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.

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid

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). These claims will deny with EOB code 066 Clinical Pre-Authorization Required. The new form will be available at www.lamedicaid.com.

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid

Effective April 1, 2014, pharmacy claims for 1st and/or 2nd generation antihistamines and antihistamine decongestant combination products will deny at Point of Sale (POS) when there is an active claim on the recipient's file for another antihistamine or antihistamine decongestant combination product. Claims will deny with EOB 482-Therapeutic Duplication. See www.lamedicaid.com.

ATTENTION PROVIDERS: 2014 Podiatry Code List Update

It has been brought to the attention of DHH that the listing of podiatry procedure codes located in Appendix G of the Professional Services Manual currently includes procedure codes for anesthesia services that are not payable to podiatrists. This includes all codes that begin with '01'.

Appendix G of the Professional Service Manual is being updated to remove the incorrect codes. The updated manual will be posted at www.lamedicaid.com. You will be notified when the revisions are complete.

National Healthcare Decisions Day
April 16, 2014
Conversations Change Lives: Talk To Your Patients About Advance Care Planning

Visit the LaPOST website at: www.la-post.org for additional information.

ATTENTION ALL PROVIDERS

Effective November 20, 2013, eligible recipients can now receive both hospice care and long term personal care services (LTPCS) concurrently without duplication of services. Please visit www.lamedicaid.com for additional clarification or review the upcoming Provider Update.