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 http://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.

Reminder: Effective with Dates of Service On or After September 1, 2016
New Medicaid Requirements for Ordering, Prescribing, and Referring Providers

The Affordable Care Act (ACA) requires physicians or other practitioners who order, prescribe, or refer items or services to Medicaid recipients to enroll in the Louisiana (LA) Medicaid Program, even when they do not submit claims to Medicaid. These requirements are designed to ensure items or services for Medicaid recipients originate from appropriately licensed providers who have not been excluded from Medicare or Medicaid.

LA Medicaid will begin denying fee-for-service claims, effective with dates of service on or after September 1, 2016 when the ordering, prescribing, or referring provider is not enrolled in LA Medicaid. Please see the detailed notice titled, “Requirements for Ordering, Prescribing, and Referring Providers” on the LA Medicaid website (www.lamedicaid.com), dated May 11, 2016 for more information concerning this requirement and billing information.

For questions related to this information as it pertains to fee-for-service Medicaid claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.

Reminder: Effective with Dates of Service On or After September 1, 2016
New Medicaid Requirements for Entering Attending and Referring Providers on Institutional Claims

Effective with dates of service on or after September 1, 2016, Institutional fee-for-service provider claims (Hospital, Hospice, End Stage Renal Disease, Nursing Facility and ICF/DD and Home Health) will deny for issues related to Attending and Referring provider data sent.

Edit 444 will be set for issues related to Attending provider data reported on the UB04/837I claim and Edits 144 and 090 will be set for issues related to Referring provider data. For more information regarding these changes, please see the detailed notice on the LA Medicaid website (www.lamedicaid.com), titled, “Requirements for Attending and Referring Providers on Institutional Claims,” dated May 11, 2016.

For questions related to this information as it pertains to fee-for-service Medicaid claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.

ATTENTION RURAL HEALTH CLINICS:
The Process for Annual PPS Rate Adjustment Notification is Changing

In the past, each Rural Health Clinic (RHC) has received an annual letter indicating the updated prospective payment system (PPS) rate for the facility. Beginning with updates for State Fiscal Year (SFY) 2017, RHCs who receive rate increases based on the Medicare Economic Index (MEI) will no longer receive a letter notifying them of their annual PPS rate adjustment.

The MEI is the determining factor for the yearly change in the PPS rates for most RHCs. For SFY 2017, that began July 1, 2016, each RHC’s current rate increased by 1.1 percent. The updated PPS rates have been completed for the RHCs via the Medicaid published fee schedule, available on the Medicaid website (www.lamedicaid.com) under the Fee Schedules link.

The RHCs which receive rate changes based on cost reports will continue to receive letters indicating the change and the attestation form indicating their chosen rate.

If you have questions about the content of this message, you may contact Molina Provider Relations at 1-800-473-2783.

Attention Fee for Service (FFS) Louisiana Medicaid Providers:

Effective August 4, 2016 FFS Medicaid Pharmacy Program will cover mosquito repellent to decrease the risk of exposure to the Zika virus. Please refer to http://www.lamedicaid.com/provweb1/Pharmacy/pharmacyindex.htm for more information.

Attention Fee for Service (FFS) Louisiana Medicaid Providers:

Effective August 15, 2016, the Fee for Service (FFS) Louisiana Medicaid Pharmacy Program has updated the clinical pre-authorization criteria for Direct-Acting Antiviral (DAA) Agents used to treat Hepatitis C Virus (HCV). Please refer to www.lamedicaid.com for specifics.

Attention All Fee for Service (FFS) Louisiana Medicaid Providers
Elimination of the Requirement to Submit the Recipient Retroactive Eligibility Certification Form with Claims
When the Certification is Retroactive to Cover Claim Dates of Service Over 1 Year

Previously, in cases where a recipient’s eligibility certification was made retroactive to cover services over 1 year old, providers were required to submit the recipient’s retroactive eligibility certification form with their claim(s) in order to be paid. Since these claims could not be submitted within the timely filing limit, the date of the certification form allowed the claims to be special handled and have the timely filing edits bypassed (272/Claim Exceeds 1 Year Filing Limit; and 371/Attachment Requires Review/Filing Deadline).

Logic changes have been made in the Fee for Service Medicaid system to modify these edits. With this modification, the claims processing system will use the date entered into the system from the Medicaid Eligibility Determination System file in order to make the timely filing determination and process the claims.

This change is effective for claims received on or after August 9, 2016. This change should streamline this process for providers; eliminate the need to request a certification form; and allow providers to submit these claims electronically rather than hard copy with justification. In the future if you receive timely filing denials on claims where you believe retroactive eligibility certification should apply, you may submit a paper claim with a letter of inquiry concerning the recipient’s eligibility to:

Louisiana Department of Health
Louisiana Medicaid Program
Attn: Deborah Davis
P.O. Box 91030
Baton Rouge, LA 70821