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

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 Fee for Service (FFS) Louisiana Medicaid Providers:

Effective May 1, 2017, Fee-for-Service (FFS) pharmacy claims for opioid prescription products exceeding 120 MME (Morphine Milligram Equivalence) will trigger an educational alert at Point of Sale (POS). The purpose of the educational alert is to inform providers of the upcoming MME policy. Please refer to for more information.

Providers of Clinical Laboratory Services - Fee Reimbursement Changes

Federal regulations prohibit state Medicaid agencies from reimbursing providers of clinical laboratory services at a higher rate than the Medicare allowable rate. In accordance with this regulation, clinical laboratory reimbursement rates have been adjusted on the fee-for-service Medicaid file and are effective for dates of service January 1, 2017 forward. The Laboratory Fee Schedule has been updated to reflect those changes.

Clinical laboratory claims for dates of service on or after January 1, 2017 where the previous reimbursement exceeded the Louisiana Medicare allowable rate will be systematically recycled on the remittance of May 9, 2017 without any action required by the provider.

Please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040 if there are questions related to this matter for fee for service claims.

Louisiana Medicaid Fee Schedule Publishing Change

Beginning April 28, 2017, the published Medicaid fee-for-service fee schedules for Professional Services, Laboratory/Radiology, and Take Charge Plus will be refreshed by Molina on a weekly basis. (Previously these fee schedules were refreshed monthly.) This change was implemented to inform both providers and managed care organizations (MCOs) of Medicaid fee-for-service procedure file updates in a more timely manner.

These and the other published fee schedules are found on the Louisiana Medicaid website, using the ‘Fee Schedule’ link.


Rate increases for certain non-rural, non-state hospitals have been approved effective for dates of service 1/1/17 due to the provisions contained in HRC 51 of the 2016 Legislative Session. These rate increases are now posted online at under "fee schedules".

As a result, previously processed claims with dates of service after 1/1/17 will be recycled/adjusted on the remittance advice of May 9, 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.