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.

Attention Hospice Care Providers and Agencies:

Effective immediately, providers now have up to 5 calendar days to submit the Notices of Revocation, Discharge, Transfer and Void to the Prior Authorization Unit (PAU) at DXC Technology.

Providers are reminded that failure to submit Notices of Revocation, Discharge or Transfer in a timely manner can result in the inability for other providers to bill for Medicaid services. Late submissions will be monitored by the department and PAU, and may be subject to monetary penalties.

Information regarding this policy can be found on under the Provider Manuals link, within the Hospice provider manual.

Questions regarding this message and fee-for-service claims should be directed to DXC Technology Provider Relations at (800) 473-2783 or (225) 924-5040.

Questions related to managed care claims should be directed to the appropriate Managed Care Organization (MCO).

Attention Enteral Nutrition and Oral Supplement Providers

Effective May 1, 2019, and with dates of service forward, Louisiana Medicaid will no longer cover the Nutrabalance Protein Cookies listed under HCPCS code B4153 on the DME Enteral Nutrition Fee Schedule.

The following National Drug Codes (NDCs) will no longer be available in the DME program:


Providers must reach out to prescribing physicians and recipients to determine a replacement alternative as a source of protein for recipients. LDH is requesting that providers work with DXC Technology to cut back prior authorizations and reduce units in order to submit new prior authorizations that include the physician’s replacement source of protein for recipients. DXC Technology was instructed not to approve new prior authorization for the NutraBalance protein cookie past dates of service 4/30/2019.

Attention Federally Qualified Health Centers (FQHC) and Rural Health Clinic (RHC) Providers

Effective April 1, 2019, and with dates of service forward, Louisiana Medicaid has established an alternative payment methodology (APM) for behavioral health services provided in FQHC and RHC facilities. All FQHC and RHC providers should review the Informational Bulletin at for additional information regarding this change.

LDH is requesting that RHC and FQHC providers hold all behavioral health claim submissions, with dates of service beginning April 1, 2019, until further notification from LDH. This will allow DXC Technology time to prepare their systems for processing these claims. Claims submitted prior to system updates may result in denial or incorrect payment requiring submission of claim adjustments.

LDH will notify RHC and FQHC providers once the system can accept these claims.

Information regarding this change is forthcoming and will be located on under the Provider Manuals link, within the FQHC and RHC Provider manual. An update the FQHC and RHC fee schedules is also forthcoming.

Questions regarding this notice and fee for service claims should be directed to DXC Technology Provider Relations at (800) 473‐2783 or (225) 924-5040.