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.

Primary Care Services Enhanced Reimbursement Update

The deadline to submit a Designated Physician form and receive an effective date for enhanced reimbursement retrospective to January 1, 2013 has been extended further. The deadline is now June 28, 2013. If Molina Provider Enrollment receives your complete and correct form by June 28, 2013, you will receive enhanced reimbursement for eligible services rendered on or after January 1, 2013. If your complete and correct form is received after June 28, 2013, you will receive enhanced reimbursement for eligible services rendered on or after the date the form is received.

If you submitted a Designated Physician form to PRJSM but have not received notice from Molina that it was received, you must submit an original Designated Physician form to Molina. The current Designated Physician form (revised on 4/8/13) can be found at

For additional information, please review "ATTENTION PRIMARY CARE PROVIDERS: Affordable Care Act Enhanced Reimbursement of Primary Care Services Informational Bulletin" posted on

Eligible Medicaid Providers are encouraged to participate in a National Provider Call, hosted by CMS, on Thursday, May 30th for the Medicare and Medicaid Incentive Programs. See registration and other information below. National Provider Call: Stage 1 of the Medicare & Medicaid EHR Incentive Programs for Eligible Professionals: First in a Series ? Registration Now Open Thursday May 30; 12:30-2 PM CT,

This session will inform individual practitioners on the basics of Stage 1 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Learn if you are eligible, and if so, what you need to do to earn an incentive. This is the first in a series of 6 National Provider Calls on the Medicare and Medicaid EHR Incentive Programs.


  • Are you eligible?
  • How much are the incentives and how are they calculated?
  • How do you get started?
  • What are major milestones regarding participation and payment?
  • How do you report on meaningful use?
  • Where can you find helpful resources?
  • Question and Answer Session

Registration Information:

In order to receive call-in information, you must register for the call on the  CMS Upcoming National Provider Calls registration website. Registration will close at 12pm on the day of the call or when available space has been filled; no exceptions will be made, so please register early.

Future National Provider Calls:




June 27

2:30 - 3:45

Certification w/ONC

July 23

1:30 - 3


July 24

1:30 - 3

Stage 2

Aug 13

1:30 - 3

Hardship Exceptions

Aug 15

1:30 - 3

Payment Adjustments

Psychiatric Services: 2013 CPT Changes

In association with the 2013 HCPCS update, Louisiana Medicaid fee for service has established policy related to reimbursement of the new psychiatric diagnostic and psychotherapy procedure codes. Effective with dates of service May 21, 2013 and forward, it is the intent of Louisiana Medicaid to only reimburse providers for these services (currently CPT codes 90791-92 and 90832-90840) when there are face-to-face services where the patient is present and must be clearly documented in the patient record. This policy supersedes recommendations or changes in procedure code descriptions in the Current Procedural Terminology manual for these services. For questions related to this information, please contact Molina Medicaid Provider Services at (800) 473-2783 or (225) 924-5040.

For policy related to Louisiana Behavioral Health Partnership (LBHP), consult the LBHP Services Manuel at

Update to 'ClaimCheck' Product Editing

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, National Correct Coding Initiative (NCCI) edits, and/or provider specialty society updates. The 'ClaimCheck' product's procedure code edits are guided by these widely accepted industry standards.

The edit changes will affect claims processed begiooiog with tbe remittance advice of May 21, 2013 forward. Providers may notice some differences in claims editing that includes pre/post´┐Ż op days, incidental, mutually exclusive, rebundling, add-on 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.

With this update, Louisiana Medicaid (claims that process through the Molina claims processing system) also implemented the 2013 quarter one NCCI edits; however, the code pairs specific to preventive services and immunization administration have been deactivated based CMS approval. Doing so aligns with our intent and expectations that appropriate immunizations are to be given at the time of the preventive visit to avoid missed opportunities in both preventive care and immunizations.


The deadline for receiving 2013 Annual EDI Certification Forms has passed. If you have not submitted a 2013 Certification form for your submitter number (beginning with 450), immediate action is required. Failure to submit the required form by May 31, 2013 will result in deactivation of the submitter number. If a number is deactivated, the Certification form will have to be received in the Molina EDI Department hardcopy (no faxes or email attachments accepted) before the number is reactivated. This will result in a delay in payment for your providers. If we already received your 2013 form, you or your vendor would have received an email from us confirming receipt. If you have any questions, call the EDI Department at (225) 216-6303.


The 2013 HCPCS code update is complete and appropriate codes have been added to the Louisiana Medicaid fee schedule effective with the RA of April 02, 2013. Claims billed with 2013 codes that denied prior to this addition are recycled on the 05/14/13 RA. Some claims billed with 2013 codes were paid prior to the implementation of the recent 1% rate reduction retroactive to February 1, 2013. These claims are systematically recycled and paid at the reduced fee on the 05/14/13 RA. No action is necessary by Providers.