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

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: All Providers

All providers should now use the current TPL update form entitled “Medicaid Recipient Insurance Information Update” form, located at Directions for locating the form are provided below. Providers should fax the form to the correct Bayou Health Plan (BHP) for each Medicaid recipient.

Beginning July 1, 2015, the Department of Health and Hospitals (DHH) will no longer forward the TPL update forms received on Bayou Health Plan recipients to the applicable Bayou Health Plan (BHP).

If there is no medical insurance on the DHH/BHP file for the member, submit the claim to the BHP as secondary with the medical insurance information. The Bayou Health Plan will process the claim accordingly as the secondary payer and add the TPL information to the BHP/DHH file for future claims.

If the member has medical insurance information on the DHH/BHP file and it differs from the information that the PROVIDER has, the PROVIDER must submit the medical insurance information in which the member is enrolled and call the BHP call center or fax the TPL update form directly to the BHP for TPL updates to occur.

Plan Fax Phone Preferred Method
Amerihealth Caritas LA 1-215-863-5221 1-888-922-0007 Call
Aetna Better Health 1-844-479-2590 1-855-242-0802 Fax
Amerigroup 1-855-363-0727 1-800-454-3730 Fax
LA Healthcare Conn 1-866-768-9374 1-866-595-8133 Call
United Healthcare 1-877-324-8202 1-866-675-1607 Call

If the recipient is still enrolled in traditional Medicaid (no BHP managed care plan), the form should be faxed to DHH.

  Fax Phone Preferred Method
DHH 1-225-342-1376 225-342-8662 Fax

All previous forms are now obsolete and should no longer be submitted.

The new form can be found at Click on Forms/Files/User Manuals on the left navigational bar. Then, click on Online Forms. Scroll down to Medicaid Recipient Insurance Information Update Form - Private Insurance Plans and Medicare Advantage Plans. Fill in form, print and fax to the plan or DHH.


A review of hospital claims has identified two issues related to billing claims with revenue code 761. Claims processing logic changes were made in April to prevent reimbursement for claims billed inappropriately with revenue code 761. All claims with dates of service January 1, 2014 forward that are related to the issues identified below and paid in error will be systematically voided on the RA of June 30, 2015.

1. Some hospitals were billing ambulatory surgical procedure codes with revenue code 761 rather than with revenue code 490. Policy is clear that any procedures listed on the Hospital Outpatient Ambulatory Surgery Fee Schedule must be billed with revenue code 490. Billing these claims with an incorrect revenue code allowed some claims to process incorrectly and overpay. Once these ambulatory surgery claims are systematically voided on the RA of June 30, providers may resubmit claims appropriately using revenue code 490.

2. Additionally, some hospitals were billing immunizations and immunization administration with revenue code 761. Immunizations and the immunization administration are professional services and should not be billed by hospitals. Payments made for immunizations and/or the immunization administration billed with revenue code 761 were in error and will be voided on the RA of June 30. These claims may not be resubmitted.

The billing of a clinic visit (HR 510, 514, 515, 517, or 519) for the use of space and supplies is allowable.

Please contact Molina Provider Relations (800) 473-2783 or (225) 924-5040 for questions.

Attention Pharmacists and Prescribing Providers of Louisiana Legacy Medicaid:

Effective July 1, 2015 the drugs listed in the table below will no longer be covered as a Pharmacy Benefit.

Drug generic Description Drug Brand Description NDC
Esomeprazole Capsule 20mg Nexium 24 HR 00573-2450-14
Esomeprazole Capsule 20mg Nexium 24 HR 00573-2450-28
Esomeprazole Capsule 20mg Nexium 24 HR 00573-2450-42
Esomeprazole Capsule 20mg Nexium 24 HR 00573-2450-43
Guaifenesin/Phenylephrine HCI J-Max Syrup OTC 64661-0011-16
Polyethylene Glycol 3350 Polyethylene Glycol 3350 00904-6025-77

Attention Providers Billing Transplant Related Services

DHH was recently made aware that claims from billing providers for 'transplant related services,' which include transplant diagnosis codes, are denying with edit 960 (Attach BHSF Authorization Letter and Operative Report). It has been determined that these 'transplant related services' were inadvertently denied, and all claims will be reprocessed on the RA of June 30, 2015. Claims may either pay or receive additional denial reasons which need to be addressed. This recycle does not include hospital inpatient claims for the actual transplant. Policy changes for billing of transplants and transplant related claims will be forthcoming.

ICD-10 Webinars

ATTENTION ALL MEDICAID PROVIDERS: Louisiana Medicaid is hosting provider webinars concerning the ICD-10 implementation for Louisiana Medicaid claims. These webinars are being offered to allow providers an opportunity to get information concerning this transition and to ask questions related to the ICD-10 implementation. Please see the detailed notice on the web site,, concerning the dates and times of these webinars.