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 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.


Starting July 18, 2013, a notice was posted on Molina's web site and in RA messages from Molina informing providers that effective 8/6/2013 (date of payment), Medicare crossover claims for Behavioral Health services would be denied with new edit 133 and the claims would automatically be sent to Magellan for processing. We are notifying you that there is a delay in the automatic transfer, but that it will occur, just at a point toward the end of this month or early in September. Providers will continue to see these denials (edit 133) in Molina's processing system, and all of these claims (with payment date 8/6/2013 and after) will be transmitted to Magellan. No action is required on the part of the provider. We apologize for any inconvenience this may cause.