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.


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.


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).

Attention Providers: Medicaid RAC Provider Education Seminar

The Department of Health and Hospitals and Myers and Stauffer LC is hosting a Provider Education Seminar on the new Medicaid Recovery Audit Contractor (RAC) program mandated by the Centers for Medicare and Medicaid Services (CMS). Seating for the seminar is limited and will be reserved by registration only. The seminar will be streamed live for those who are not present at the seminar and recorded for future viewing by those providers who cannot attend or view by live stream.

To reserve a seat, please register for the RAC Provider Education Seminar by emailing:

Please include specific questions you or your organization may have about the RAC in your email.

Date: September 18, 2013
Time: Seating begins at 8:30 a.m., seminar 9:00 a.m. - 11:00 a.m.
Location: 628 North 4th Street, Baton Rouge-1st floor, room 118


It has been brought to the Department's attention that the fee schedules for outpatient hospitals had an incorrect indicator displaying. The fee schedules incorrectly indicated that reimbursement for some procedure codes were being limited to crossover claims only. This was an error on the fee schedules that is being fixed. Claim reimbursement was not impacted by this error therefore no recycle/resubmission of claims is needed.

Attention Pharmacists and Prescribing Providers:

Pharmacy claims for shared health plan or legacy Medicaid recipients for combination acetaminophen products will continue to deny when the dose of acetaminophen exceeds four (4) grams per day; claims for combination aspirin products will still deny when the dose exceeds six (6) grams per day. Dosing will be accumulated from all active prescriptions. The denial cannot be overridden through Point of Sale claims processing.

Attention Providers with Erroneously Denied or Pended Claims on July 30, 2013 RA Edits 043, 190, 200 and 201

On the check write dated July 30, 2013, we experienced a claims processing issue involving claims requiring prior authorization. This caused some erroneous claim denials and pends. The identified edits associated with these incorrect denials are 043, 190, 200 and 201.

We will reprocess these claims on the provider's behalf and will enter them into the claims processing system with a new Internal Control Number (ICN) in order to capture the correct Prior Authorization number as originally submitted on the claim. These reprocessed claims will not pend for pre-pay review. Original claims and adjustments/voids will be included. They will be adjudicated in the check write dated August 6, 2013.

Claims related to this error that are pending for edit 190 (PA Number Not on File) and appear in the "Claims in Process" section of the July 30th RA are being reprocessed with a new ICN. However, the pended claims with erroneous PA numbers will continue to pend until they are systematically released. Since we are also reprocessing these claims as original claims, you may see edit 190 denials in the remittances of August 6th or August 13th as these claims move through the system to final adjudication.

Please reconcile your claims against the reprocessed claims from the August 6th RA. If other claims appear to have been denied due to this processing error or due to provider billing error, please resubmit any outstanding claims.

We regret any inconvenience this error has caused.