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.
For information regarding the medication policy and/or criteria associated with this denial, providers
may access the Louisiana Medicaid Preferred Drug List (PDL) / Non-Preferred Drug List at
PAYMENT ERROR RATE MEASUREMENT (PERM) 2021 IS NOW IN PROGRESS
Louisiana Medicaid is mandated to participate in the Centers for Medicare and Medicaid (CMS) Payment Error Rate Measurement (PERM) program which will assess our payment accuracy rate for the Medicaid and CHIP programs. If chosen in a random sample, your organization will soon receive a Medical Records Request from the CMS review contractor, AdvanceMed. This cycle measurement will review Medicaid and CHIP payments made in Reporting Year (RY) 2021: July 1, 2019 through June 30, 2020.
Please be advised that sampled providers who fail to cooperate with the CMS contractor by established deadlines may be subject to sanctioning by Louisiana Medicaid Program Integrity through the imposition of a payment recovery by means of a withholding of payment until the overpayment is satisfied, and/or a fine.
Please be reminded that providers who are no longer doing business with Louisiana Medicaid are obligated to retain recipient records for 5 years, under the terms of the Provider Enrollment Agreement.
For more information about PERM and your role as a provider, please visit the Provider link on the CMS PERM website:
2021 HCPCS and Physician-Administered Drug Reimbursement Updates
The Louisiana Medicaid fee-for-service (FFS) files have been updated to reflect the new and deleted Healthcare Common Procedure Coding System (HCPCS) codes effective for dates of service beginning on January 1, 2021. Providers will begin to see these changes on the remittance advice of March 23, 2021. Claims that have been denied due to use of the new 2021 codes prior to their addition to the claims processing system will be systematically recycled with no action required by providers.
Effective for dates of service beginning on January 1, 2021, Louisiana Medicaid updated the reimbursement rates on the FFS file for physician-administered drugs and payable vaccines for Professional Services. Claims previously submitted for these drugs or vaccines with dates of service on or after January 1, 2021 will be systematically adjusted to ensure proper payment. No action is required by the provider.
For questions related to this information as it pertains to fee-for-service Medicaid claims processing, please contact Gainwell Technologies Provider Services at (800) 473-2783 or (225) 924-5040.
Questions regarding managed care claims should be directed to the appropriate managed care organization.
2021 Assistant Surgeon and Assistant at Surgery Services
Louisiana Medicaid has published the 2021 fee-for-service (FFS) list of allowed procedures for assistant surgeon and assistant at surgery providers.
The list has been posted to the LA Medicaid website (www.lamedicaid.com) under the ClaimCheck icon.
The list is based on updates made by 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 FFS Medicaid claims processing, please contact Gainwell Technologies Provider Services at (800) 473-2783 or (225) 924-5040.
Please contact the appropriate managed care organization with any questions concerning their 2021 HCPCS updates.