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 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 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.
Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and
Effective April 16, 2014, pharmacy claims for anti-anxiety drugs will deny with EOB
482-Therapeutic Duplication when there is already an active claim in the same
therapeutic class. Quantity limits will be applied on certain anxiolytics, as listed on the
website. Diagnosis codes will be required for alprazolam ER and ODT and recipients
must be 18 years of age or older on the date of service. See www.lamedicaid.com.
Attention Providers Submitting Medicare/Medicaid Crossover Claims: Sequestration Reduction is Provider Responsibility
In 2013, Medicare imposed a 2% reduction in Medicare payments (sequestration). This
reduction applies to both Medicare and Medicare Advantage Plan payments to providers of
services. Therefore, for services provided under assignment, the reduced Medicare payment
would be considered payment in full to the provider (meaning that the provider's payment
receives the 2% reduction). The patient responsibility amount remains unchanged. All
Medicare/Medicaid claims are 'assigned' claims.
It has come to the Department's attention that some providers are incorrectly completing
the Medicare Advantage key sheets for submission to Medicaid by including the 2% reduction
amount in either the Medicare 'Paid' field or the Patient Responsibility field on the key
sheet. We have also received calls from some providers asking why the 2% reduction was not
taken into consideration when processing Medicare Crossover claims submitted Medicaid.
As indicated above, the 2% reduction is subtracted from a provider's payment and cannot
be included as a part of the Medicare payment amount or the patient responsibility amount.
Please ensure that claims and Medicare Advantage plan key sheets are completed and
submitted correctly for processing.
INFORMATIONAL UPDATE TRANSITION TO THE NEW CMS-1500 (02/12) FORM FAST APPROACHING
FOR PAPER CLAIMS SUBMITTED TO MOLINA AND BAYOU HEALTH SHARED PLANS
Providers were notified in our notice dated February 14, 2014 of Louisiana Medicaid's plans to transition to
the revised CMS 1500 (02/12) claim form for paper billing to Molina and Bayou Health Shared Plans.
CLAIM FORM CHANGES:
The significant form change that impacts Medicaid billing is the addition of 8 diagnosis codes to Form
Locator 21 (for a total of 12 diagnosis codes) and the addition of an ICD Indicator (to specify whether ICD-9
or ICD-10 is being used). Other changes to the form do not impact your claims submitted to Louisiana
Currently, providers may submit either version 08/05 or version 02/12 of the 1500 claim form. Effective
April 30, 2014, Molina will only accept the new CMS 1500 (02/12). After this date, original claims and
claim resubmissions must be submitted on version 02/12 - regardless of the date of service.
Important Information for Providers: Although we will accept, key, and capture up to 8 diagnosis codes
from the new claim form, claims editing will not change at this time; thus, only the first 4 diagnosis codes
are carried through claims processing, and editing is based on current Medicaid policy.
Until the implementation of ICD-10 diagnosis coding, only ICD-9 diagnosis codes are acceptable for billing
PROGRAM CHANGES PLANNED FOR THIS TRANSITION TO THE CMS 1500 FORM:
As we implement the newly revised form, the following changes will be made to transition programs to the
CMS 1500 claim form:
- Professional providers (Physicians, DME, and Professional Crossover) currently using the
proprietary 213 Adjustment/Void Forms will be required to use the CMS 1500 02/12 for that
Beginning May 19, 2014, professional providers will be required to use the
CMS 1500 02/12 In place of the 213 Form.
- Free Standing Rehabilitation Center providers will be required to transition from the currently used
proprietary 102 Claim Form and 202 Adjustment/Void Form to using the CMS 1500 02/12 for
original claims, for adjustments and for voids.
Until further notice, providers using the 102 Claim Form and the 202 Adjustment/Void
Form should continue to submit on those forms. Additional information concerning
timelines for these program transitions and new billing instructions will be forthcoming.
NOTE: Please visit the Medicaid web site, www.lamedicaid.com, for upcoming information. Billing
instructions are being placed on the directory link, Billing Information.