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 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.

Attention Providers of Home Health Services

The Home Health fee schedule has been updated to include all modifiers available for Extended Home Health services (HCPCS codes S9123 and S9124). Providers should submit any new Prior Authorization (PA) requests with the appropriate and applicable modifier to the PA department at DXC Technology, with documentation supporting its request.

Providers may also submit a reconsideration request for currently approved PAs for Extended Home Health services. For cases currently identified as chronic needs, PA may be submitted as normal, for continuation of services. Providers may later submit a reconsideration request if they wish to apply for any applicable modifiers, along with any supporting documentation.

For any claims previously paid and adjudicated as part of a currently approved PA, providers should submit an adjustment, including the newly approved modifier(s), for reevaluation.

Information regarding the available modifiers, criteria, and documentation required for PA requests can be found at www.lamedicaid.com under the Provider Manuals link, within the Home Health manual chapter. The updated Home Health fee schedule, including current reimbursement rates, can be found at www.lamedicaid.com under the Fee Schedules link.

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 Laboratory Services

Effective for dates of service on or after August 1, 2019, Louisiana Medicaid will require all professional service and independent laboratory providers to include a valid CLIA number on all claims submitted for laboratory services, including CLIA waived tests. Claims submitted with an absent, incorrect or invalid CLIA number will deny.

For claims submitted using the CMS-1500 form, the CLIA number will be required in block 23. Providers should refer to the CMS 1500 Billing Instructions under the Billing Information link at www.lamedicaid.com, where complete instructions will be provided. The CLIA number is not required for UB-04 claims.

Information regarding this policy change is forthcoming and will be found on www.lamedicaid.com under the Provider Manuals link, within the Professional Services and Independent Laboratory manuals.

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 Ordering Providers and Providers of Laboratory Services

Effective for dates of service on or after July 1, 2019, Louisiana Medicaid has adopted the following changes to the coverage of definitive drug testing:

  • Definitive drug testing is limited to 18 total tests per member per calendar year. CPT codes 80320-80377 for individual substance(s) or metabolites will no longer be covered. Providers should instead use HCPCS codes G0480 (Drug tests, definitive…per day, 1-7 drug class(es), including metabolite(s) if performed) or G0481 (Drug tests, definitive…per day, 8-14 drug class(es), including metabolite(s) if performed) or their successors.

    Testing more than fourteen definitive drug classes per day is not reimbursable.

  • Presumptive drug testing is limited to 24 total tests per member per calendar year. Providers are to consider the methodology used when selecting the appropriate procedure code for the presumptive testing

No more than one presumptive and one definitive test will be reimbursed per day per recipient, from the same or different provider.

Information regarding this policy is forthcoming and will be found on www.lamedicaid.com under the Provider Manuals link, within the Professional Services and Independent Laboratory Services manuals. Fee schedules will be updated accordingly and can be found at the appropriate link 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.