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 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.

ATTENTION NURSING HOME ADMINISTRATIORS

As part of the budget reduction measures by the Department of Health and Hospitals, Medicaid will no longer pay co-insurance on therapy services (physical therapy, occupational therapy and speech/language therapy) on Medicare/Medicaid Cross-over claims effective with Date of Service July 1, 2012. Claims billed on or after this date of service will '0' pay with edit 384 -NOT COVERED FOR NURSING HOME RESIDENT. If you have questions please contact Denis Beard at 225-342-6116.

EHR INCENTIVE PAYMENT PROGRAM - UPDATE

Since January 2011, nearly 1,300 eligible medical professionals and hospitals have received more than $120 million in incentive payments through participation in Louisiana's Medicaid Electronic Health Records (EHR) Incentive Payment Program. The EHR Incentive Payment Program is a 100% federally funded initiative that promotes the adoption and meaningful use of certified EHR technology through the provision of incentive payments to eligible professionals and hospitals. Eligible professionals can receive a maximum of $63,750 in incentive payments over a six-year period, and in 2011, the average payment to Louisiana's participating hospitals was $1.1 million.

BILATERAL PROCEDURES: BILLING CLARIFICATION

When billing for bilateral procedures performed during the same session (unless otherwise directed in CPT), providers are to use the -50 modifier (Bilateral procedure) with the appropriate CPT code and place a "1" in the units field of the claim form. The site specific modifiers 'LT' (Left side) or 'RT' (Right side) may be used on appropriate CPT codes only when services are performed on either the right OR the left side. Providers should not use the 'LT' and 'RT' modifier on the same procedure code instead of the -50 modifier. For example, during the same session it is not appropriate to use the 'RT' and 'LT' on CPT procedure code 69436 (Tympanostomy...) when performed bilaterally. For questions related to this clarification, please contact Molina Medicaid Solutions Provider Services at (800)-473-2783 or (225)-924-5040.