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


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.


Effective for DOS on/after 3/1/2011, methodology for Outlier payments for under age 1 and 6 has been changed. Refer to the emergency rule published by the Office of the State Registrar in the 3/20/2011, LA Reg: Outlier cases with DOS before 3/1/2011 will pay as they have in the past, EXCEPT that submissions MUST BE RECEIVED AT DHH NO LATER THAN 5/31/2011. Cases with covered charges of less than $150,000 before 3/1/2011 may qualify for outlier payments if a patient is still in the hospital on/after 3/1/2011, and covered charges for the entire inpatient stay reaches/ exceeds $150,000. Regardless of any existing billing/payment issue for DOS claims prior to 3/1/2011, if a hospital feels they are owed Outlier payment, THEY SHOULD SUBMIT CLAIMS NO LATER THAN 5/31/2011.