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 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.

BILLING FOR RECIPIENTS ENROLLED IN A BAYOU HEALTH SHARED PLAN

The following services are not provided by the Shared Plans and will continue to be prior authorized and/or paid through Molina:

Dental, Pharmacy, Waiver services, Durable Medical Equipment, Long-Term Personal Care Services, EPSDT Personal Care Services, Hospice, Emergency and Non-Emergency Transportation Services, Nursing Facility, Intermediate Care Facilities for the Developmentally Disabled, Specialized Behavioral or Mental Health professional services, Case Management, Adult Day Health Care, EPSDT Health Services and Early Steps case management and medical services.

All other services must be billed to the BAYOU HEALTH Shared Plan the recipient is enrolled with.

BILLING FOR RECIPIENTS ENROLLED IN A BAYOU HEALTH PREPAID PLAN

The following are services not provided by the Prepaid Plans and will continue to be prior authorized and/or paid through Molina:

Dental, Pharmacy, Waiver services, Long-Term Personal Care Services, EPSDT Personal Care Services, Hospice, Nursing Facility, Intermediate Care Facilities for the Developmentally Disabled, Specialized Behavioral or Mental Health professional services, Case Management, Adult Day Health Care, EPSDT Health Services and Early Steps case management and medical services.

All other services must be billed to the BAYOU HEALTH Prepaid Plan the recipient is enrolled with.

THE FOLLOWING 5 MESSAGES ARE DIRECTED TOWARDS
BAYOU HEALTH PROVIDERS IN GSA-B (REGIONS 2, 3, AND 4)

1. ATTENTION LOUISIANA MEDICAID PROVIDERS

Effective for dates of service on or after 4/1/2012, claims for Medicaid State Plan Services provided to BAYOU HEALTH Plan members must be submitted to the Health Plan the member is linked to. If they are billed directly to Molina, the claims will deny, advising you to submit the claim to the Health Plan. Claims for carved out services not covered under BAYOU HEALTH Plans will continue to be billed to Molina. For further information, visit the website at www.makingmedicaidbetter.com. Click on the Providers link, and review the list of carved out services located on the 'Medicaid Provider Billing Changes for Dates of Service Beginning April 1, 2012' document.

2. ATTENTION PRIMARY CARE PROVIDERS (PCPs)

Have you enrolled with a BAYOU HEALTH Plan yet? If not, starting 4/1/12, you will no longer receive reimbursement for providing services to Louisiana Medicaid recipients enrolled in a BAYOU HEALTH Plan unless you have contracted with or made other arrangements with a BAYOU HEALTH Plan. For further information, visit the website at www.makingmedicaidbetter.com or participate in daily phone calls being held Monday through Friday with DHH by calling 1-888-278-0296, passcode 7299088.

3. ATTENTION LOUISIANA MEDICAID PROVIDERS

The CommunityCARE and KIDMED programs are ending statewide with the implementation of BAYOU HEALTH. As BAYOU HEALTH phases into a Geographic Service Area (GSA), CommunityCARE and KIDMED linkages for enrollees residing in the GSA will terminate.

There will be no new CommunityCARE or KIDMED provider enrollment applications processed. Provision of EPSDT screening services for KIDMED enrollees transitioning into BAYOU HEALTH will be the responsibility of the individual Health Plans.

Existing PCPs are notified of the procedure for ensuring uninterrupted medical care for transitioning CommunityCARE/KIDMED enrollees as BAYOU HEALTH implementation begins in the GSA. Notices for GSA B may be viewed at: www.la-communitycare.com, www.makingmedicaidbetter.com, or www.lamedicaid.com.

4. ATTENTION COMMUNITYCARE PROVIDERS

Current CommunityCARE Primary Care Providers (PCPs) that intend to continue rendering care to Louisiana Medicaid recipients as PCPs in the BAYOU HEALTH program must ensure that each Health Plan is provided with the 7-digit Medicaid legacy provider ID and corresponding NPI enrolled in CommunityCARE. PCPs with CommunityCARE linkages at more than one location must also include the appropriate 3-digit site number for each enrolled location. This information is available on the CommunityCARE CP-0-92 reports submitted for payment of the monthly management fees.

NOTE: Physician group practices, FQHCs, and RHCs must also provide the Medicaid IDs and NPIs for the individual practitioners at each CommunityCARE-enrolled location.

For assistance verifying the enrolled Medicaid legacy provider ID, PCPs may also contact the CommunityCARE contractor at 1-800-259-4444, option #3.

5. VERIFYING HEALTH PLAN & ELIGIBILITY INFORMATION FOR BAYOU HEALTH MEMBERS

Effective 4-1-2012, REVS, MEVS, and E-MEVS applications will show the name of the BAYOU HEALTH PLAN and their phone number for Medicaid recipients enrolled in BAYOU HEALTH. Enrollment in a BAYOU HEALTH Plan is for the entire calendar month. This information will be located where current CommunityCare PCP information is, and will no longer contain the PCP name. You may obtain PCP information from the BAYOU HEALTH Plan.

TO BAYOU HEALTH PROVIDERS ONLY IN GSA-A (Regions 1 and 9)
AND GSA-B (Regions 2, 3, 4)
UPDATE TO VERIFYING FUTURE MONTH HEALTH PLAN & ELIGIBILITY
INFORMATION FOR BAYOU HEALTH MEMBERS ONLY

DHH has completed revisions that will allow future month Health Plan and eligibility information to be shown in MEVS and e-MEVS. Revisions allow providers to obtain future enrollment information for dates of service up to 3 months. However, Plan Enrollment into a BAYOU HEALTH Plan may be prospective, and a recipient's eligibility for coverage under a Plan may be subject to change. Therefore, to ensure that you are using accurate and up-to-date eligibility information, it is your responsibility to re-check eligibility status with e-MEVS and your MEVS vendor prior to and on the date of service. If you fail to do so, and if you consequently provide services to a recipient who is ineligible on the date of service, you will not be paid for those services.

REMINDER TO BAYOU HEALTH PLAN PROVIDERS

Claims for enrollees in the Prepaid Plans must be billed to and will be paid by the BAYOU HEALTH Plan. Claims for enrollees in the Shared Plans must be billed to Bayou Health Plan for pre-processing and then submitted by the Plan to Molina for adjudication and payment. Please refer to lamedicaid.com for the memo "Medicaid Billing Changes for Dates of Service Beginning February 1, 2012."

ATTENTION ALL PROVIDERS 2012 HCPCS UPDATE

The Louisiana Medicaid files have been updated to reflect the new and deleted HCPCS codes for 2012. Providers began seeing these changes on the RA of March 6, 2012. The Professional Services Fee Schedule on the LA Medicaid website, www.lamedicaid.com, has been updated. Claims denied due to use of the new 2012 codes prior to their addition to our system will be systematically adjusted on April 03,2012.

Providers will see denials of codes with 2012 date of service that were deleted effective December 31, 2011. Those claims should be resubmitted with the correct 2012 code.

Additionally, the "Assistant Surgeon/Assistant at Surgery Covered Procedures List" under the 'Claimcheck' icon on the website will be updated to reflect the addition of applicable 2012 procedure codes. As a reminder, 'Claimcheck' uses the American College of Surgeons (ACS) as its primary source for determining assistant surgeon designations.

ATTENTION LOUISIANA MEDICAID PROVIDERS

The Louisiana Medicaid Nurse Helpline will be discontinued effective Monday, April 30, 2012, at 5:00pm. This service was provided through the contract for administration of the CommunityCARE and KIDMED programs. BAYOU HEALTH plans will assume responsibility for providing this service to their members as the program is implemented into each of the three Geographic Service Areas (GSA) of the state.

Members are to call:

Amerigroup - 1-800-600-4441
Community Health Solutions - 1-855-247-5248
LaCare - 1-888-756-0004
Louisiana Healthcare Connections - 1-866-595-8133
United Healthcare Community Plan - 1-866-675-1607

Providers in GSAs A and B should immediately remove all references to the Louisiana Medicaid Nurse Helpline from patient literature and office messaging. Providers in GSA C, the final area of the state scheduled for BAYOU HEALTH implementation, must have this process completed by April 30th.

ATTENTION ALL PROVIDERS: POLICY CLARIFICATION FOR BREAST
RECONSTRUCTION SURGERY

Breast reconstruction surgery performed after a mastectomy is a covered service, but breast reconstruction to establish symmetry with contralateral breast is not covered. Tattooing the areola of the breast and reconstruction procedures to achieve symmetry of the breasts will not be covered by Louisiana Medicaid.

ATTENTION ALL NON-EMERGENCY TRANSPORTATION PROVIDERS

Claims for Non-Emergency claims and Prior Authorization for these services were being denied erroneously effective 2/1/12 as a result of implementation changes for the BAYOU HEALTH Plan. Corrections have since been made to correctly allow the claims to pay if an appropriate Prior Authorization is on file. Claims that were previously denied for February and March are being systematically recycled for potential payment and will show up on the 4/10/12 RA.