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 OUTPATIENT HOSPITAL AND OUTPATIENT HOSPITAL CLINIC PROVIDERS:
It was recently noted that hospital revenue codes (HR) 300 through 319 were not paying the laboratory services correctly. They should have priced based on the HCPC submitted on the claim but instead were paying a cost to charge ratio. In addition, some claims were not being edited for correct HCPCS that are required to be billed with these revenue codes. Adjustments have been made to correct this issue which began with the June 28th Remittance Advice.
As a result, previously processed claims containing HR 300-319 will be recycled / adjusted on the remittance advice of April 11, 2017 without any action required on behalf of the provider.
Questions regarding this message should be directed to Molina Provider Relations at (800) 473-2783 or (225) 924-5040.