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.

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, www.lamedicaid.com, 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 http://www.lamedicaid.com/provweb1/billing_information/medicaid_billing_index.htm. 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 http://www.lamedicaid.com/provweb1/HIPAA/5010v_HIPAA_Index.htm. 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.