PROVIDERS, PLEASE NOTE!!!
If you are unsure
about the coverage of a drug product, please contact the PBM help desk
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
Attention Pharmacy Providers
Effective 05/02/2012 copay
logic has been modified to calculate & deduct the copayment amount from
the amount allowed for recipients enrolled in the following waiver
programs: "Support Waiver", "Residential Options Waiver", and "Community
Choice Waiver" programs. (See Section 37.6.5 of "Louisiana Medicaid
Program Provider Manual").
Should you have any questions
regarding any of the following messages, please contact Molina Medicaid
Solutions at (800) 473-2783 or (225) 924-5040.
TO BAYOU HEALTH PROVIDERS ONLY IN GSA-A
(Regions 1 and 9)
AND GSA-B (Regions 2, 3, 4)
UPDATE TO VERIFYING FUTURE MONTH HEALTH PLAN & ELIGIBILITY
INFORMATION FOR BAYOU HEALTH MEMBERS ONLY
DHH has completed revisions that will allow future
month Health Plan and eligibility information to be shown in MEVS and
e-MEVS. Revisions allow providers to obtain future enrollment
information for dates of service up to 3 months. However, Plan
Enrollment into a BAYOU HEALTH Plan may be prospective, and a
recipient's eligibility for coverage under a Plan may be subject to
change. Therefore, to ensure that you are using accurate and up-to-date
eligibility information, it is your responsibility to re-check
eligibility status with e-MEVS and your MEVS vendor prior to and on the
date of service. If you fail to do so, and if you consequently provide
services to a recipient who is ineligible on the date of service, you
will not be paid for those services.
IMPORTANT NOTICE TO ALL MEDICAID HOSPICE
The Department of Health and
Hospitals will partner with Molina Medicaid Solutions to administer the
Medicaid Hospice Program. Effective May 1, 2012, Hospice providers are
to appropriately submit all hospice prior authorization requests and
related forms to:
Molina Medicaid Solutions via e-PA System @www.lamedicaid.com
Please check the lamedicaid.com website for upcoming webinar training
dates. Questions regarding hospice prior authorizations should be
directed to Molina's Prior Authorization Unit at 1-800-877-0666, option
2, effective May 1, 2012.
ATTENTION LOUISIANA MEDICAID PROVIDERS
The Louisiana Medicaid Nurse Helpline will be discontinued
effective Monday, April 30, 2012, at 5:00pm. This service was provided through
the contract for administration of the CommunityCARE and KIDMED programs. BAYOU
HEALTH plans will assume responsibility for providing this service to their
members as the program is implemented into each of the three Geographic Service
Areas (GSA) of the state.
Members are to call:
Amerigroup - 1-800-600-4441
Community Health Solutions - 1-855-247-5248
LaCare - 1-888-756-0004
Louisiana Healthcare Connections - 1-866-595-8133
United Healthcare Community Plan - 1-866-675-1607
Providers in GSAs A and B should immediately remove all
references to the Louisiana Medicaid Nurse Helpline from patient literature and
office messaging. Providers in GSA C, the final area of the state scheduled for
BAYOU HEALTH implementation, must have this process completed by April 30th.
ATTENTION HOSPITAL PROVIDERS
Revenue code 278 requires the use of a HCPC code with the revenue code.
Revenue code 279 does not require the use of a HCPC code with the
FAMILY PLANNING WAIVER TAKE CHARGE PROVIDERS
As a result of updates to the 2012 CPT Codes, effective 12/31/2011, CPT
codes 11975 (Insertion or Reinsertion, Implantable), 11976 (Removal of
an Implantable Contraceptive Capsule), and 11977 (Removal with Reinsertion, Implantable) are no longer payable under the Family Planning
Waiver "Take Charge Program." Please use CPT codes 11981 (Insertion,
Non-Biodegradable Drug Delivery Implant), 11982 (Removal, Non-Biodegradable Drug Delivery Implant) and 11983 (Removal with Reinsertion,
Non-Biodegradable Drug Implant) as appropriate. These changes are
effective as of 1/1/2012. Please re-submit any denied claims related
to these procedure codes with the correct 2012 CPT Code.
IMPORTANT NOTICE TO ALL MEDICAID HOSPICE PROVIDERS
The Hospice Service Manual and related forms have been updated and
revised. Requirements and procedures have changed regarding the election
of hospice services. The revised manual and forms can be reviewed
online at www.lamedicaid.com -> Provider Manuals.
Providers may begin using the revised forms upon reviewing the revised
manual. The older version of the forms will become obsolete effective
June 1, 2012. Older versions of the forms will not be accepted after
this date. Providers must follow the new procedures when submitting requests for
hospice services. Failure to adhere to the new requirements may cause a delay in processing a request for hospice services.
DHH will implement an
Electronic Visit Verification (EVV) system for Home and Community Based
Services (HCBS) in the fall of 2012. Providers considering purchasing an
EVV system may wish to reconsider pending this implementation. Further
information will be made available as the project moves forward.