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.
PAYMENT ERROR RATE MEASUREMENT (PERM) 2017 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, CNI Advantage.
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: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/PERM/Providers.html.
Professional Component of Clinical Laboratory Services – Fee Reimbursement Changes
Under Federal regulation, state Medicaid agencies are prohibited from reimbursing providers of clinical laboratory (lab) services at a higher rate than the Medicare allowable rate. In accordance with this regulation, clinical lab reimbursement rates were updated earlier this year and a recycle of clinical lab services was performed in May. Since that time, the fee for the professional component of a few additional lab services has been updated.
Clinical lab claims for dates of service on or after January 1, 2017 where the previous reimbursement exceeded the Louisiana Medicare allowable rate will be systematically recycled on the remittance of July 25, 2017 without any action required by the provider.
Please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040 if there are questions related to this matter for fee for service claims.
On behalf of the Louisiana Department of Health (LDH), Health Management Systems
(HMS) will hold a webinar for Institutional and Professional fee-for-service
enrolled providers on August 30, 2017 at 2:00 p.m. CST. HMS will present an
overview of their Provider Operations Department, Disallowance project
processes, and Provider Portal benefits. The webinar offers a unique opportunity
for providers to review current practices and participate in a question/answer
forum. LDH encourages all Providers to
enroll in this webinar by registering at
Please contact HMS’s Provider Operations Department toll free at (888) 831-2738
for assistance in viewing on-line disallowances through Provider Portal.