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 PROFESSIONAL SERVICE PROVIDERS AND OUTPATIENT HOSPITALS
DIABETES SELF MANAGEMENT TRAINING (DSMT)

Effective February 20, 2011, Louisiana Medicaid will provide coverage for Diabetes Self-Management Training services rendered to Medicaid recipients diagnosed with diabetes. For coverage details and policy information, please refer to www.lamedicaid.com. Providers should contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with billing or policy questions.

ATTENTION PROVIDERS OF KIDMED SERVICES

Louisiana Medicaid reminds KIDMED screening providers of the KIDMED Screening Periodicity Policy, as published in the 2007 Louisiana Medicaid KIDMED Provider Training, page 10. Periodic screenings performed on children less than two years of age must be at least 30 days apart and periodic screenings performed on children/adolescents who are two years of age or older must be at least six months apart. Medically necessary preventive/well-child screenings performed that do not meet this minimum number of calendar days/months between screenings should be billed as KIDMED interperiodic screenings. Example: A seven day old infant has a KIDMED medical screening performed and three weeks later (21 calendar days) another screening is provided, the second screening should be billed as an interperiodic screening as it was performed less than 30 calendar days from the previous screening. Contact Molina Medicaid Solutions Provider Relations at (800) 473-2783 or (225) 924-5040 should you have any questions.

ATTENTION HOSPITAL, PHYSICIAN AND BILLING PROVIDERS
IMPORTANT INFORMATION CONCERNING
CHANGE IN PRECERTIFICATION REQUIREMENT FOR STERILIZATIONS

As we have implemented new policies related to inpatient stays for deliveries, we have received requests from hospital providers to remove the precertification requirement currently in place for sterilizations performed on the first or second day of the inpatient hospitalization. The edit that requires precertification for sterilizations has been removed from the claims system. The removal of this edit does not change the requirement for submission of OFS Form 96 or the hysterectomy acknowledgement form with the claim.

Please visit www.lamedicaid.com for the detailed provider notice related to this change.

ATTENTION KIDMED PROVIDERS: NEWBORN SCREENING POLICY UPDATE

Policy Update: Based on a Rule published in the Louisiana Register Vol. 34, No. 03 March 20, 2008 by the Office of Public Health, Louisiana Medicaid has revised the KIDMED policy related to repeat newborn/neonatal heel stick screenings. Providers must rescreen an infant whose newborn screening (e.g. PKU) was done prior to 24 hours of age, a change from the previous policy of prior to 48 hours of age. These rescreenings are to be done at the first medical visit, preferably between one and two weeks of age but no later than the third week of life. To view the complete revised KIDMED Neonatal/Newborn Screening policy and updated KIDMED Periodicity Schedule go to the 'KIDMED Newborn Screening' link on the home page of www.lamedicaid.com. The updated KIDMED Periodicity Schedule can also be found on the KIDMED website, www.la-kidmed.com, following the link for Publications & Forms. Contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040 should you have any questions.