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.

Should you have any questions regarding any of the following messages, please contact Molina Medicaid Solutions at (800) 473-2783 or (225) 924-5040.

THE FOLLOWING 6 MESSAGES ARE DIRECTED TOWARDS
BAYOU HEALTH PROVIDERS IN GSA-C (REGIONS 5, 6, 7, and 8)

ATTENTION LOUISIANA MEDICAID PROVIDERS

Effective for dates of service on or after 6/1/2012, claims for Medicaid State Plan Services provided to BAYOU HEALTH Plan members, must be submitted to the Health Plan the member is linked to. If they are billed directly to Molina, the claims will deny, advising you to submit the claim to the Health Plan. Claims for carved out services not covered under BAYOU HEALTH Plans will continue to be billed to Molina. For further information, visit the website at www.makingmedicaidbetter.com. Click on the Providers link, and review the list of carved out services located on the 'Medicaid Provider Billing Changes for Dates of Service beginning June 1, 2012' document.

ATTENTION PRIMARY CARE PROVIDERS (PCPs)

Have you enrolled with a BAYOU HEALTH Plan yet? If not, starting 6/1/12, you will no longer receive reimbursement for providing services to Louisiana Medicaid recipients enrolled in a BAYOU HEALTH Plan unless you have contracted with or made other arrangements with a BAYOU HEALTH Plan. For further information, visit the website at www.makingmedicaidbetter.com or participate in daily phone calls being held Monday through Friday with DHH by calling 1-888-278-0296, passcode 7299088.

ATTENTION LOUISIANA MEDICAID PROVIDERS

The CommunityCARE and KIDMED programs are ending statewide with the implementation of BAYOU HEALTH. As BAYOU HEALTH phases into a Geographic Service Area (GSA), CommunityCARE and KIDMED linkages for enrollees residing in the GSA'S have been terminated.

There will be no new CommunityCARE or KIDMED provider enrollment applications processed. Provision of EPSDT screening services for KIDMED enrollees transitioning into BAYOU HEALTH will be the responsibility of the individual Health Plans.

Existing PCPs are notified of the procedure for ensuring uninterrupted medical care for transitioning CommunityCARE/KIDMED enrollees as BAYOU HEALTH implementation begins in the GSA. Notices for GSA C may be viewed at: www.makingmedicaidbetter.com, or www.lamedicaid.com.

ATTENTION COMMUNITYCARE PROVIDERS

Current CommunityCARE Primary Care Providers (PCPs), that intend to continue rendering care to Louisiana Medicaid recipients as PCPs in the BAYOU HEALTH program, must ensure that each Health Plan is provided with the 7-digit Medicaid legacy provider ID and corresponding NPI enrolled in CommunityCARE. PCPs with CommunityCARE linkages at more than one location must also include the appropriate 3-digit site number for each enrolled location.

NOTE: Physician group practices, FQHCs, and RHCs must also provide the Medicaid IDs and NPIs for the individual practitioners at each CommunityCARE-enrolled location.

VERIFYING HEALTH PLAN & ELIGIBILITY INFORMATION FOR BAYOU HEALTH MEMBERS

Effective 4-1-2012, REVS, MEVS, and E-MEVS applications will show the name of the BAYOU HEALTH PLAN and their phone number for Medicaid recipients enrolled in BAYOU HEALTH. Enrollment in a BAYOU HEALTH Plan is for the entire calendar month. This information will be located where current CommunityCare PCP information is and will no longer contain the PCP name. You may obtain PCP information from the BAYOU HEALTH Plan.

ATTENTION LOUISIANA MEDICAID PROVIDERS

Effective May 1, 2012, CommunityCARE and KIDMED referrals/authorizations will no longer be required. Claims for services provided to enrollees with dates of service in May 2012 will bypass the CommunityCARE 106 and KIDMED 424 error edits when billed to Louisiana Medicaid.

ATTENTION PROVIDERS WITH CLAIMS SENT TO UNITED HEALTHCARE OF LOUISIANA

Molina experienced a claims processing system error that caused some outpatient claims forwarded to us by United Healthcare of Louisiana to drop from processing the week of May 21, 2012. These claims will be put into the system this week and adjudicated in the June 5th check write cycle. We regret any inconvenience caused by this issue. Any questions can be directed to Molina Provider Relations at 1-800-473-2783 or 225-924-5040.

ATTENTION HOSPITAL PROVIDERS

Effective for dates of service July 1, 2012, and thereafter; Louisiana Medicaid is mandated to meet the requirements of 42 CFR Part 447, Subpart A, and sections 1902(a)(4), 1902(a)(6), and 1903 with respect to non-payment for Provider Preventable Conditions (PPC's) including Health Care Acquired Conditions (HCAC's). Please refer to www.lamedicaid.com for the detailed policy and billing instructions. The guidance applies to fee-for-service claims including the shared savings Bayou Health Plans. The Prepaid Bayou Health Plans are required to implement their own procedures for non-payment for the same events when applicable to their enrollees. Providers should contact the plans to obtain additional information.

ATTENTION ALL PROVIDERS

With the implementation of the new pre-payment review payment process some duplicate claims have been detected within the LA Medicaid payment system. These duplicate claims are now being voided and will appear on this remittance. Action has been taken to exclude such duplicate claims in the future.