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.


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

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.

Billing of Shared Plan Claims to Molina after July 31, 2015

Claims for Bayou Health Shared Savings Plan members formerly enrolled in CHS or UHC with dates of prior to February 1, 2015, should be submitted for payment to the appropriate Shared Savings Plan no later than July 31, 2015. After July 31, 2015, claims for these members must be submitted directly to Molina for payment. Claims submitted to CHS and UHC after July 31, 2015 will deny with edit 998 “submit claim to Molina for processing”.

When submitting claims to Molina, please adhere to the instructions below:

  • Hard Copy Claims – Use billing instructions provided for your provider/claim type found at Reminder: Always submit claims with the 13 digit Medicaid Recipient ID and 7 digit Legacy Medicaid provider number for billing and servicing providers when submitting claims to Molina. Include appropriate attachments and/or proof of timely filing if necessary.
  • Electronic Claims – Use the appropriate 837 electronic transaction in the 5010 HIPAA Companion Guide for your provider/claim type found at Again, always submit claims with the 13 digit Medicaid Recipient ID number.

If you have any questions, please contact Molina’s Provider Relations at 1-800-473-2783.

Attention Pharmacists and Prescribing Providers of Louisiana Legacy Medicaid:

Effective July 15, 2015, a new EOB of 346 will be implemented for Fee For Service (FFS) pharmacy claims. This will impact the Medicare/Medicaid Dual Eligible recipients. EOB 346—Bill Medicare Part B for qualified services otherwise bill Medicare Part D; Bill Medicare Part D/B (short message). The drug categories included are oral anti-emetics, oral chemotherapy, ESRD agents, immune globulins, immunosuppressants, and inhalation solutions.

Attention Pharmacists of Louisiana Medicaid (Fee For Service and Managed Care):

NCPDP field 481-HA (flat tax field) has been identified for the placement of the $0.10 provider fee. Please begin submitting the $0.10 provider fee in this field on July 24, 2015 for all pharmacy Medicaid claims, Fee For Service and Managed Care.