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.
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 https://hmsonline.webex.com/hmsonline/j.php?MTID=m13c54f99e66b1b2e411823d70bda2ea2
Please contact HMS’s Provider Operations Department toll free at (888) 831-2738 for assistance in viewing on-line disallowances through Provider Portal.”
ATTENTION OUTPATIENT HOSPITAL SERVICES PROVIDERS:
During a recent claims processing system update, it was noted that the reimbursement for immunizations to outpatient hospital services providers was incorrect. The referenced processing error resulted in an overpayment to providers. This error has been corrected. Affected claims will be adjusted resulting in a recovery of the overpayments without any action on behalf of the provider. This adjustment will be included on the RA for Tuesday, August 22, 2017.
For questions regarding this message and/or fee for service claims, please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040.
Updates to Healthy Louisiana related systems and claims processing changes are plan specific and are the responsibility of each health plan. For questions regarding Healthy Louisiana updates, please contact the appropriate health plan.