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
Should you have any questions
regarding any of the following messages, please contact Molina Medicaid
Solutions at (800) 473-2783 or (225) 924-5040.
For information regarding the medication policy and/or criteria associated with this denial, providers
may access the Louisiana Medicaid Preferred Drug List (PDL) / Non-Preferred Drug List at
PAYMENT ERROR RATE MEASUREMENT (PERM) 2021 IS NOW IN PROGRESS
Louisiana Medicaid is mandated to participate in the Centers for Medicare and Medicaid (CMS) Payment Error Rate Measurement (PERM) program which will assess our payment accuracy rate for the Medicaid and CHIP programs. If chosen in a random sample, your organization will soon receive a Medical Records Request from the CMS review contractor, AdvanceMed. This cycle measurement will review Medicaid and CHIP payments made in Reporting Year (RY) 2021: July 1, 2019 through June 30, 2020.
Please be advised that sampled providers who fail to cooperate with the CMS contractor by established deadlines may be subject to sanctioning by Louisiana Medicaid Program Integrity through the imposition of a payment recovery by means of a withholding of payment until the overpayment is satisfied, and/or a fine.
Please be reminded that providers who are no longer doing business with Louisiana Medicaid are obligated to retain recipient records for 5 years, under the terms of the Provider Enrollment Agreement.
For more information about PERM and your role as a provider, please visit the Provider link on the CMS PERM website:
Long-term Electroencephalography (EEG) Setup and Monitoring
Effective with dates of service on and after January 1, 2020, Louisiana Medicaid covers the services represented by CPT codes for long-term EEG setup and monitoring by an EEG technologist, currently CPT procedure codes 95700 and 95705-95716.
Providers furnishing long-term electroencephalography (EEG) services must adhere to CPT coding guidance. Specifically, providers must follow CPT guidance on the definitions of unmonitored, intermittent, and continuously monitored studies. In addition, providers must ensure that all EEG technologists have the relevant qualifications and training as listed in CPT guidance.
Claims for the services listed above that have been denied will be recycled to ensure proper reimbursement. No action is required by providers.
For questions related to this information as it pertains to fee-for-service Medicaid claims processing, please contact DXC Technology Provider Services at (800) 473-2783 or (225) 924-5040.
Questions regarding managed care claims should be directed to the appropriate managed care organization.