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 Professional Services Providers: Prior Authorization Required for Brentuximab Vedotin
J9042: Brentuximab Vedotin is a new code included in the HCPCS updates for 2013. Effective April 18, 2013, Louisiana Medicaid will require prior authorization for the chemotherapy
drug J9042: Brentuximab Vedotin. Brentuximab Vedotin is a chemotherapy drug used in the treatment of
Hodgkin�s lymphoma after failure of an autologous stem cell transplant or failure of at least two multidrug
chemotherapy regimens. Brentuximab Vedotin is also used for treatment of systemic anaplastic large-cell
lymphoma after failure of at least one prior multidrug chemotherapy regimen.
If you have any questions, please contact Molina Provider relations at (800)473-2783 or (225)924-5040.
On March 19, 2013, Judge Brian Jackson issued his Ruling and Order in Joseph Taylor v State of
Louisiana, Through the Department of Health and Hospitals, et al, Civil Action Number 09-1068,
United States District Court, Middle District of Louisiana declaring LAC 50:1.8341-8349 (Pursuit
of the Difference Rule} preempted by existing Federal law to the extent LAC 50:1.8341-8349 permits a
health care provider to recoup the balance of its customary payment from third-party settlement
proceeds after the provider has accepted payment from Medicaid.
In light of Judge Jackson's ruling, it is the position of the Department of Health and Hospitals/Medicaid
Program that medical providers may no longer pursue collection and/or accept payment of the "Difference";
accordingly the "Notification to Louisiana Medicaid" form is no longer being accepted by the Department of
Health and Hospitals/Medicaid Program.
Should you have any questions regarding pursuit of and/or acceptance of payment of the "Difference", please
contact your legal adviser.
Attention Professional Services and Non-Hospital Ambulatory Providers: 2013 HCPCS Update
The Louisiana Medicaid files have been updated to reflect the new and deleted HCPCS codes for 2013.
Providers began to see these changes on the RA of April 2, 2013. Claims denied due to use of the new
2013 codes prior to this update will be recycled once the fee schedules are completed.
Molina is currently updating the Professional Services Fee Schedule on the Louisiana Medicaid Website,
Additionally, the �Assistant Surgeon/Assistant at Surgery Covered Procedures List� under the blue �Claim Check�
icon on the website homepage has been updated to reflect applicable 2013 procedure codes. As a reminder,
�Claim Check� uses the American College of Surgeons (ACS) as its primary source for determining appropriate
assistant surgeon designations.
For questions related to this information, please contact Molina Medicaid Provider Services at
(800) 473-2783 or (225) 924-5040.
ATTENTION: ALL PROVIDERS BILLING MEDICAID RECIPIENTS FOR SERVICES
This message is to remind all providers that within your agreement of participation with Louisiana Medicaid you
agree to accept the Medicaid payment as payment in full for services rendered to Medicaid recipients, providing
for the allowances for co-payments authorized by Medicaid.
A recipient may be billed for services that have been determined as non-covered or exceeding the services limit
for recipients over the age of 21. Recipients are also responsible for all services rendered after his/her
eligibility has ended. Providers shall not bill recipients in instances where provider billing errors have
caused a denied claim. In order to bill a recipient for a non-covered service, the recipient must be informed
both verbally and in writing that he/she will be responsible for payment of the services.
NOTE: A recipient delay in receiving authorized Medicaid covered services are prohibited by Louisiana Medicaid.
ATTENTION Professionals and Hospitals Eligible for the EHR Incentive Payment Program
On May 1, 2013, Louisiana Medicaid will launch the NEW AND IMPROVED LAConnect, the online portal for eligible providers to
apply for Medicaid EHR incentive payments. On May 1st, eligible professionals and hospitals will be able to access the new
system via lamedicaid.com and complete the attestation process for Adoption, Implementation, or Upgrade or Meaningful Use of
certified electronic health technology. To attest, go to lamedicaid.com, enter your logon credentials, and click on the LAConnect link.