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 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.


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.


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 Medicaid.

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 Medicaid.


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 purpose.
    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,, for upcoming information. Billing instructions are being placed on the directory link, Billing Information.



The Centers for Medicare & Medicaid Services (CMS) will be hosting PERM Provider Education Conference Calls/Webinars this summer, to provide interactive sessions for providers of Medicaid and Children's Health Insurance Program (CHIP) services. Providers will be informed about PERM updates, trends and responsibilities. There will be opportunities to ask questions and provide feedback to CMS and your state representatives.

For Webinar details, refer to the March/April, 2014 Provider Update Article, located in the Provider portal at


Effective with date of service May 1, 2014, Makena (J1725) administered via intramuscular injection for the prevention of preterm delivery is covered by Medicaid through the Professional Services program.

Please visit to view the web posting for complete details.

ATTENTION PROVIDERS: ACA Enhanced Reimbursement 2014 Rates

On April 4, 2014 Molina updated the Affordable Care Act Primary Care Services Enhanced Reimbursement rates to reflect the Medicare rates for dates of service in calendar year 2014. Claims paid on the April 15, 2014 Remittance Advice were the first to be affected. The 2014 Professional Services - ACA Enhanced Reimbursement fee schedules for Primary Care Services and Immunization Administration are being posted to The 2013 fee schedules will also remain available on the site.

DHH will advise providers when a recycle is expected to adjust claims which have already been processed for dates of service in calendar year 2014 and paid before April 14, 2014. In addition, programming logic is currently being updated to allow eligible Medicare crossover claims to pay correctly. Any crossover claims affected to date will be processed in a separate recycle.

Please continue to review the RA messages and web notices as you will be notified when these recycles will occur. We apologize for any inconvenience these issues have caused.

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid:

Effective May 1, 2014, pharmacy claims for hydrocodone containing drugs will be limited to 720 units in a rolling 365 days. These limits are in addition to the current limits. See

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid:

Effective April 23, 2014, pharmacy claims for Progesterone Vaginal Suppositories with applicable NDCs will be reimbursed when submitted. Quantity limits will be applied as listed on the website. See

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid:

Effective May 12, 2014, pharmacy claims for Victrelis® (boceprevir), Incivek® (telaprevir), Sovaldi® (sofosbuvir), and Olysio® (simeprevir) will have a limited duration of therapy. On May 19, 2014 quantity limits will be applied to these medications. Please refer to for specifics.