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.

Attention Professional Services Providers:

It has been brought to the attention of DHH that some of the fees for the new 2013 HCPCS codes were inadvertently added prior to budgetary reductions. Additionally, revisions have been made to CPT codes 95017 and 95018 to accurately reflect the new descriptions, units, and fees.

The above items have been corrected and the Professional Services Fee Schedule has been updated. All impacted claims will be recycled for potential recoupment and/or adjustment of funds. No action is required by providers.

Scheduled Claims Recycle for Primary Care Services with Affordable Care Act Enhanced Rates

DHH has authorized a special check write scheduled for Wednesday, July 17, 2013, in order to address prior paid claims for specified primary care services rendered by Designated Providers which are eligible for an enhanced rate as required by the Affordable Care Act (ACA). As CMS approved our methodology on June 6, 2013, the ACA enhanced rates were added to the claims processing system on June 17, 2013 and eligible Designated Providers began to see higher payment of these services beginning with the June 25, 2013 check write. The new check write will address claims for dates of service January 1 through June 16, 2013 which were processed before we implemented the enhanced rates into our processing system. EFTs will be released on Thursday, July 18.

Only claims paid under legacy Medicaid or Bayou Health Shared Savings plans (Community Health Solutions of America and United Healthcare) will be affected. DHH requires approval from CMS regarding the methodology to reimburse enhanced rates for the Prepaid Plans.

Physicians whose Designated Physician form was processed and approved by Molina Provider Enrollment prior to June 17, 2013 will be included in the recycle and systematic adjustment of claims. Advanced Practice Registered Nurses eligible for enhanced rate payment will be processed at a later date.

Additionally, providers should review any claims on this check write which deny due to the patient having third-party liability (TPL). They will need to submit the claim to the other insurance first and then submit an adjustment to Molina afterwards in order to receive the enhanced rate, if applicable.

For more information related to the ACA enhanced rates and affected providers, please see "ATTENTION PRIMARY CARE PROVIDERS: Affordable Care Act Primary Care Services Enhanced Reimbursement Information" posted to on June 16, 2013.


Currently all Behavior Health claims from Medicare (Crossover Claims) are being denied for edit 555 (SUBMIT CLAIM TO LBHP SMO) indicating that the claims should be submitted to Magellan for payment. Effective with the August 6, 2013 Date of Payment, Medicare Crossover Claims will be denied with new edit 133 (BEHAVIORAL HEALTH CROSSOVER SENT TO SMO (MAGELLAN)). Molina will automatically forward these claims to Magellan for appropriate processing. Once this new edit is in place, no action will be required by the providers. (CMHC providers are excluded from this process and claims will continue to be processed by Molina.)

If you have questions or concerns, please contact Lou Ann Owen at (225) 342-1353, or LouAnn.Owen@LA.GOV.


The ACA notice posted below dated 06/18/13 indicates in Question 12 that for dates of service January 1, 2013 through February 19, 2013, rates for E&M services will reimburse at the Medicare rate applicable to the non-facility setting. During the systematic adjust process that occurred on the RA of 07/17/13, claims with these dates of service were incorrectly adjusted to the facility rate. The online ACA Fee Schedule for dates January 1, 2013 through February 19, 2013 also indicates the facility rate instead of the non-facility rate.

A second systematic adjustment of these incorrectly paid claims (service dates January 1st through February 19th) will occur within the next few weeks and the fee schedule will be corrected. Please continue to review the RA messages and web notices as you will be notified when this second recycle occurs. We apologize for any inconvenience this has caused.


Effective for dates of service on and after August 1, 2013, changes will be imposed for the Dental Programs including reimbursement changes and revised policy. Implementation of these changes may be delayed if required programming changes are not complete; however, if this occurs, Medicaid will recycle affected claims. Complete details will be placed on the website under the 'Dental Providers', and 'Fee Schedule' links. If you have questions, you may contact the LSU Dental Medicaid Unit at 504-941-8206 or 1-866-263-6534 (toll-free).


Providers were notified that the ACA enhanced rates adjustments which were reflected on the 07/17/13 RA were incorrectly priced at the facility rate. This only affected certain claims with dates of service 01/01/13 through 02/19/13. The rates have been updated in our claims system to reflect the non-facility rate, and you will see these adjustments on the 07/30/13 RA.