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.
ATTENTION PROVIDERS SUBMITTING SHARED PLAN CLAIMS TO MOLINA
Shared Plan claims received by Molina after the initial one year timely filing limit cannot be processed unless the provider is able to furnish the Shared Plans EOB or Payment Register showing the original claim was filed timely. All proof of timely filing documentation must contain the specific recipient information, provider information and date of service to be considered as proof of timely filing. It must also contain the name of the Shared Plan the claim was originally submitted to. To ensure accurate processing, please be certain that all information is legible. Claims with dates of service two years old must be submitted to DHH for review with proof of timely filing within the initial one year filing limit. These claims must meet one of the following criteria:
- The recipient was certified for retroactive Medicaid benefits, and the claims were filed within 12 months of the date that retroactive eligibility was granted.
- The recipient won a Medicare or SSI appeal in which he or she was granted retroactive Medicaid benefits.
- The failure of the claim to pay was the fault of the fiscal intermediary or the Louisiana Medicaid Program, rather than the provider’s fault, each time the claim was adjudicated.
In order to be considered for the 2-year override, request must include a cover letter describing the criterion that has been met and supporting documentation. Request received that do not meet these requirements will be returned to the provider.
If you have any questions or concerns, please contact Molina’s Provider Relations at 1-800-473-2783.
ATTENTION ALL PROVIDERS:
Information on the current Bayou Health open enrollment period for existing and soon to be enrolled Louisiana Medicaid Bayou Health plan members can be found at
Please visit www.makingmedicaidbetter.com if you have any questions regarding this matter.
Attention Pharmacists of Louisiana Medicaid Fee for Service:
Effective September 15, 2015 Louisiana Medicaid will reimburse enrolled pharmacies for
influenza vaccines and the administration of the vaccines per program policy. If you submit a
pharmacy claim for a flu vaccine on line through the Point of Sale (POS) system, the Professional
Service Code Medication Administration (MA) is required in the NCPDP field 440-E5. Claims without a
MA value entered will deny. The following fields are also required as part of the POS claim: vaccine
NDC, ingredient cost, incentive amount (administration fee), DUR/PPS Code
Counter (value of 1), Prescriber ID, Provider ID, and Provider ID qualifier. See
www.lamedicaid.com for more information and definitions of the POS fields.