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.
POLICY CLARIFICATION: Every provider is held responsible on the federal and state level for ensuring that their employees have not been excluded.
To determine if an employee or prospective employee is excluded on the state level, check the Louisiana Department of Health’s Adverse Actions website at the link below:
*Please note: The website should be checked upon hire and monthly thereafter.
This is a state database containing all individuals and providers who are excluded. You can search by name and verify with a Social Security Number (SSN) if you have one. Providers are required to maintain printed confirmation of the checks from the website as verification of compliance with this mandate. If the exclusion is learned prior to employment the provider should not employ the person or entity. If the provider learns of the exclusion after hiring the employee, the provider must notify the Louisiana Department of Health within 10 working days of discovering the exclusion. If you have any questions or comments or need to report an issue with an excluded worker or entity, please contact the Program Integrity Section via email at DHH.Medicaid.State.Exclusions@LA.gov.
There are additional mandatory checks that should be done – refer to your policy manuals, public health L.A.C. rules, remittance advice messages and provider updates for more information on the following websites: CNA-DSW State Registry, Office of Inspector General Office (OIG) national database, System for Award Management (SAM) national database.
Attention Louisiana Medicaid Providers:
Effective March 28, 2017, Fee-for-Service (FFS) Medicaid pharmacy claims for tasimelteon (Hetlioz®) and lumacaftor/ivacaftor (Orkambi®) will have Point of Sale (POS) edits and clinical
Please refer to www.lamedicaid.com for more information.
2017 HCPCS Claims Recycle
Louisiana Medicaid fee-for-service (FFS) claims processed from January 1, 2017 through March 3, 2017 that were denied due to use of the new 2017 procedure codes prior to their addition to the claims processing system and the updates made to the ‘ClaimCheck’ editing product will be recycled. Providers can expect to see the recycled claim results on the remittance advice of March 28, 2017. No action is required by providers.
The following claims are included in the recycle:
- Home Health
- Professional Services
- Laboratory and Radiology
- Ambulatory Surgical Centers (Non-Hospital)
- Free Standing Rehabilitation
- Take Charge Plus
Claims containing updates to immunization services will be recycled separately in the near future. Providers should monitor their RA messages for information regarding the recycling of the immunization claims.
Please contact Molina 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.
Louisiana Medicaid has discontinued use of the Podiatry table (Appendix D of the Professional Services Provider Manual) in its reimbursement methodology. Updates to the Professional Services Provider Manual will be forthcoming. Enrolled podiatrists may submit claims for covered services using procedure codes that are published on the Professional Services Fee Schedule and fall within the podiatrist’s scope of practice as defined by the Louisiana Podiatry Practice Act. Inappropriately paid claims are subject to Program Integrity review and recoupment.
Effective for dates of service 1/1/2016 forward, providers may resubmit denied claims for services previously excluded from the podiatry table for reimbursement as appropriate.
Questions regarding this message and fee for service claims should be directed to Molina Provider Relations at (800) 473-2783 or (225) 924-5040. For questions regarding Healthy Louisiana MCO policy, please contact the appropriate health plan.