PHARMACY PROVIDERS, PLEASE NOTE!!!

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 www.lamedicaid.com. 

ATTENTION PHARMACY PROVIDERS

Louisiana Medicaid will be updating Louisiana EOB 576 (Missing or Invalid PA/MC Code for Rx Override). EOB 576 will be linked to NCPDP code EU (Prior Authorization Type Code). EOB 576 is used for prescription limit overrides.

ATTENTION PROFESSIONAL SERVICES PROVIDERS
PROCEDURE CODES PAYABLE TO PODIATRISTS

Effective January 1, 2011, procedure codes 97597 and 97598 (Debridement, open wound, including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface areas) are payable to podiatrists. The system has been updated to reflect this change. Claims for dates of service January 1, 2011-April 4, 2011 that were adjudicated prior to April 5, 2011, will be systematically adjusted on April 19, 2011. Please contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions concerning this issue.

ATTENTION PROFESSIONAL SERVICE PROVIDERS

Optometrists enrolled in Louisiana Medicaid are considered part of the Professional Services program. Optometrists who perform eye care services that are within their scope of practice will receive Medicaid reimbursement to the same extent, and according to the same standards, as physicians who perform the same eye care services.  

UPDATE TO 'CLAIMCHECK' PRODUCT EDITING

Effective with the Remittance Advice of April 26, 2011:

McKesson's 'ClaimCheck' product is routinely updated by McKesson Corporation based on changes made to the resources used, such as Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) coding guidelines, the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule database, and/or provider specialty society updates. The 'ClaimCheck' product's procedure code edits are guided by these widely accepted industry standards. These edit changes will affect claims processed beginning with the remittance advice of April 26, 2011 forward. Providers may notice some differences in claims editing that includes Pre/Post-op Days, Incidental Mutually Exclusive, Rebundling and Multiple Surgery Reductions. Providers should expect that some claims will continue to deny for the same error, but when applicable, claims may now pay or deny for a different reason. Providers will continue to be notified when these routine updates are made in the future. For questions related to this information, please contact Molina Provider Services at (800)-473-2783 or (225)-924-5040.