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.



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

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 the administration of that function through traditional Medicaid Program was discontinued effective May 31, 2012.

Please visit 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.


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 or call the provider hotline at 1-855-701-6262. Visit 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.

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid:

Effective July 1, 2014 clinical pre-authorization will be required for the non-preferred direct-acting Hepatitis C agents: Incivek® (telaprevir), Sovaldi® (sofosbuvir), and Olysio® (simeprevir). These claims will deny with EOB code 066 Clinical PreAuthorization Required. The form and worksheet are available at

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid:

Effective July 15, 2014, pharmacy claims for hydrocodone containing drugs will deny when there is an active prescription on file and a new claim is submitted with a different prescriber. See