PHARMACY PROVIDERS, PLEASE
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.
PAYMENT ERROR RATE MEASUREMENT (PERM) 2014 PROVIDER EDUCATION WEBINARS
The Centers for Medicare & Medicaid Services (CMS) will be hosting PERM Provider Education
Conference Calls/Webinars this summer, to provide interactive sessions for providers of
Medicaid and Children's Health Insurance Program (CHIP) services. Providers will be informed
about PERM updates, trends and responsibilities. There will be opportunities to ask questions and
provide feedback to CMS and your state representatives.
For Webinar details, refer to the March/April, 2014 Provider Update Article, located in the
Provider portal at www.lamedicaid.com.
ATTENTION PROFESSIONAL SERVICES PROVIDERS:
The Professional Services Fee Schedule has been updated to reflect new HCPCS codes for
2014. This completes the annual HCPCS update for 2014. Claims that denied due to the
use of the 2014 codes prior to their addition to the procedure file will be systematically
reprocessed on the Remittance Advice (RA) of June 10, 2014. No action is required by
For questions related to this recycle, please contact Molina Medicaid Provider Services at
(800) 473-2783 or (225) 924-5040.
Oncotype DX Breast Cancer Assay Coverage:
Effective with date of service, July 1, 2014, Oncotype DX Breast Cancer Assay via Genomic
Health, Inc. will be reimbursed by the Louisiana Medicaid program. This assay provides a
prediction of chemotherapy benefit in women with certain early stage breast cancers.
Please see www.lamedicaid.com for complete details
related to coverage and billing information for Oncotype DX Breast Cancer Assay.
Attention Professional Service, DME, and Pharmacy Providers: Revision of Insulin Pump
Payment for a continuous subcutaneous insulin external infusion pump and related supplies will be authorized for
treatment of Type I diabetes when Medicaid recipients meet certain criteria. Effective with date of service June 1,
2014, Louisiana Medicaid has revised their Insulin Pump medical criteria guidelines to reflect current industry
Please visit www.lamedicaid.com to view the web
posting for complete details.
Attention Providers: Reject CommunityCARE/KlDMED Claim Submissions
Louisiana Medicaid will no longer accept CommunityCARE/KIDMED claim submissions beginning
July 1, 2014 and thereafter. The KIDMED program name for EPSDT Screening for Medicaid
recipients and tbe administration of that function through traditional Medicaid Program
was discontinued effective May 31, 2012.
Please visit www.lamedicaid.com to view the web posting for complete details.
Attention Personal Care Services Providers:
Effective with dates of service on or after June 1, 2014, Louisiana Medicaid will no longer
require the parent or guardian to be present in the home for minor children receiving
EPSDT - Personal Care Services.
For questions related to this information, please contact Molina Provider Services at
(800) 473-2783 or (225) 924-5040.
ATIENTION DENTAL PROVIDERS
MCNA will administer the dental benefits to most Medicaid enrollees beginning July 1, 2014.
Please continue to verify eligibility using MEVS/eMEVS. Effective for dates of service on
or after July 1, 2014, MCNA will pay claims. MCNA will honor all existing Medicaid approved
prior authorizations during the month of July. For any questions related to MCNA visit
their website at www.mcnala.net or call the provider hotline at 1-855-701-6262.
Visit www.lamedicaid.com for more information on
those enrollees that will continue to receive dental benefits through the Fee-For-Service
Medicaid Dental Program or call Molina Provider Relations at (800) 473-2783.
Attention DME Providers: Coverage of Compression Garments and Related Items
Louisiana Medicaid is updating the DMEPOS fee schedule effective May 1, 2014 to include
coverage of the full range of procedure codes for custom ordered/fitted compression
garments (e.g., stocking/burn garment/gradient pressure aid garment/sleeve) and the
necessary pneumatic compressors and appliances. The HCPCS code range currently includes
A6501-A6538, S8420-S8427, and E0650-E0675.
There are no established fees for most of the items; therefore when necessary, the
reimbursement rates will be manually priced in the usual manner. Because most of the
procedure codes represent items that are custom made, the following manual pricing
methodology is to be used: where there is a manufacturer's suggested retail price (MSRP),
the reimbursement will be MSRP minus (-) 23.7%. If there is no MSRP, the reimbursement
shall be the documented provider invoice fee plus (+) 6.3%.
For questions related to this information as it pertains to legacy Medicaid or Bayou Health
Shared Savings Plans claims processing, please contact Molina Medicaid Solutions Provider
Services at (800) 473-2783 or (225) 924-5040.