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 http://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.

Attention Durable Medical Equipment (DME) Providers

Effective with date of service June 1, 2019, Medicaid guidelines for oxygen probes for use with an oximeter device are being updated. DME providers will submit the appropriate HCPCS code from the DMEPOS fee schedule to bill for these supplies. The rate on file for the HCPCS code includes reimbursement for the tape. The U5 modifier (oxygen probe for use with oximeter device, disposable) must be included on the prior authorization and claim for disposable oxygen probes. If the DME provider bills for a replacement oxygen probe, a modifier would not be used.

Medicaid will publish the new oxygen probe policy in the DMEPOS provider manual on www.lamedicaid.com.

Questions regarding this message and fee for service claims should be directed to DXC Technology Provider Relations at (800) 473‐2783 or (225) 924‐5040. Questions regarding managed care claims should be directed to the appropriate managed care organization.

Attention Providers of Home Health Services

The following clarifications have been made to Home Health policy, in relation to skilled nursing and home health aide services for beneficiaries aged 21 and over.

  • Evidence of the face-to-face encounter is required by DXC Technology Prior Authorization Unit (PAU) for routine skilled nursing and home health aide services for beneficiaries aged 21 and over. If providers do not have this documentation prior to the initiation of services then the initial Prior Authorization (PA) request must be for 30 days only. Providers must submit documentation of the face-to-face encounter with the new PA request in order for services to continue to be approved.
  • Co-signing of the face-to-face encounter documentation by the beneficiary’s certifying physician is not required for beneficiaries seen by a hospitalist or allowed Non Physician Practitioner (NPP), as previously indicated in policy.
  • A physician’s order must be submitted with the PA request. A Plan of Care (POC) will be accepted in lieu of a separate physician’s order if the frequency of visits are specified. If providers are unable to obtain a signed POC for a reconsideration request an unsigned POC will be accepted for a 30 day period only. The signed POC must be submitted with the new PA request in order for services to be approved.

The updates to this policy can be found at www.lamedicaid.com under the Provider Manuals link, within the Home Health manual chapter.

Questions regarding this message and fee for service claims should be directed to DXC Technology Provider Relations at (800) 473-2783 or (225) 924-5040. Questions regarding managed care claims should be directed to the appropriate managed care organization.