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.

New Louisiana Department of Health and Hospitals Adverse Actions Web Search:

As a condition of participation in the Louisiana Medicaid Program, providers are responsible for ensuring current and potential employees, contractors and other agents and affiliates have not been excluded from participation in the Medicaid, or Medicare Program by Louisiana Medicaid, or the Department of Health and Human Services' Office of Inspector General. Providers who employ or contract with excluded individuals or entities may be subject to penalties of $10,000 for each item or services the excluded individual or entity furnished.

Providers have been previously instructed to check the websites of the Department of Health and Human Services' Office of Inspector General at and the System for Award Management (SAM) website at for any exclusion imposed at the federal level upon hire and monthly thereafter for employees and/or subcontractors that perform services that are compensated with Medicaid/Medicare funds. Please be reminded that the SAM site is only for entities, and providers do not need to check employees on the SAM site.

Effective immediately, providers should check the Louisiana Department of Health and Hospitals Adverse Actions website at upon hire and monthly thereafter for individuals and entities that have had adverse actions imposed. This is a user friendly site that allows single and multiple searches of individuals and entities. The user may also choose to export the database and have it available in an Excel spreadsheet. Providers are required to maintain proof in their records that checks were done for employees and/or subcontractors. This may be done by printing out the result of the search.

All current and previous names used such as first, middle, maiden, married or hyphenated names and aliases for all owners, employees and contractors should be checked. If an individual's or entity's name appears on these websites, this person or entity is considered excluded and is barred from working with Medicare and/or the Louisiana Medicaid Program in any capacity. If the exclusion is learned prior to employment the provider should not employ the person or entity. If the provider learns of the exclusion after hiring the provider must notify the Department of Health and Hospitals within ten working days of discovering the exclusion with the following information:

  • Name of the excluded individual or entity and

  • Status of the individual or entity (applicant or employee/contractor).

If the individual or entity is an employee or contractor, the provider should also include the following information:

  • Beginning and ending dates of the individual's or entity's employment or contract with the agency,

  • Documentation of termination of employment or contract, and

  • Type of service(s) provided by the excluded individual or entity.

These findings should be reported to: or

Department of Health and Hospitals
Program Integrity
P.O. Box 91030
Baton Rouge, LA 70821-9030

This new adverse actions web search tool does not replace the Nurse Aide Registry/Direct Service Worker Registry found at Providers that employee Certified Nursing Assistants (CNA) and Direct Service Workers (DSW) are still required to check these registries upon hire and every six months thereafter.

These requirements are identified in the Provider Enrollment Agreements, the Medical Assistance Program Integrity Law (MAPIL) cited as Louisiana Revised Statute 46:437, referenced in the Louisiana Administrative Code (LAC) Title 50 and the Code of Federal Regulations 42 CFR § 455.436.

All excluded individuals must request reinstatement after the minimum excluded period has been served. There is no automatic reinstatement at either the federal or state level.

Medicaid Transportation Call Center Changes

Effective October 1, 2014, Southeastrans Transportation Inc. will become the non-emergency medical transportation prior authorization contractor the Department of Health & Hospitals.

Clients may begin scheduling transportation for the month of October by calling 1-855-325-7565 beginning September 22, 2014. The Southeastrans Call Center is open from 6am-6pm Monday-Friday.

If a trip is already scheduled, clients may call "Where's My Ride" at 1-855-325-7566 to inquire about the existing scheduled trip. They may also call this number to let the dispatcher know that an appointment is over and that they are ready to be picked up.

Transportation providers may contact Southeastrans at 1-855-325-7570 if they have any questions, comments, or concerns regarding the transporting of clients or issues regarding their transports, authorizations, and/or claims.

Medical facilities that have an inquiry or request for patient transportation may contact Southeastrans at 1-855-325-7576.

Southeastrans Contact Numbers

New Reservations (to schedule a trip)


Where's My Ride (to inquire about an existing trip )


NEMT Provider Line


Medical Provider Line



During the period March 2014 through June 2014, some hardcopy Ambulance Medicare Part B Crossover claims were incorrectly paid by Medicaid in error. Corrective action was taken to prevent further payment issues and affected claims are now being adjusted to correct the payments. It is possible for a single provider to have adjustments appear on multiple RAs until all claims have been adjusted. Any overpayments will be recovered from current provider payments.

The adjustment Internal Control Number (ICN) will carry a weekend julian date. The first round of adjustments will appear on the RA of September 23, 2014 with an ICN beginning with 4229. These claims will appear in the adjustment section of the RA, and adjustments will be done weekly until all claim corrections are completed. In cases involving multi-line claims, the entire original claim is rekeyed/adjusted for provider convenience and auditing purposes. Some adjusted claim lines will show no difference between the original payment and the adjusted payment. We apologize for any inconvenience this has caused providers.


H2019/H2019HM are both to be used to provide one on one ABA services to Medicaid clients. Under the current constraints of the Medicaid ABA program group therapy is not to be provided.

If you have questions or concerns, please contact Rene' Huff at (225) 342-3935 or

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid:

Effective October 1, 2014, based upon guidance from Centers for Medicare & Medicaid Services (CMS), pharmacy reimbursement methodology for Louisiana Medicaid Pharmacy Fee for Service (FFS) Program will change. Please refer to for specifics.

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid:

Effective October 15, 2014, Pharmacy claims for recipients with Third Party Liability (TPL) must be submitted with the sales tax amount identified in the submission. Effective November 18, 2014, Pharmacy claims without this information submitted will deny with EOB 283, Sales Tax Not Present on Rx Claim with TPL. See


Provider Type BI is only to be used for billing purposes and should never be used for prior authorization purposes. All claims for ABA services should be submitted directly to Molina.

H2019 is used when enrolled provider provides direct service.

H2019HM is used when services are delivered via line staff (not the enrolled provider providing direct service)

G9012 is the supervisions code and should be used when the enrolled provider is supervising staff who are providing services under code H2018HM. This is only needed when H2019HN is requested.

If you have questions or concerns, please contact Rene' Huff at (225) 342-3935 or


H2019/H2019HM are both to be used to provide one on one ABA services to Medicaid clients. Under the current constraints of the Medicaid ABA program group therapy is not to be provided.

If you have questions or concerns, please contact Rene' Huff at (225) 342-3935 or

Attention Providers Billing TPL Claims and Paper Medicare Crossover Claims:

It has come to our attention that providers who submit TPL claims and paper Medicare Crossover claims to Medicaid are sending copies of primary payer EOBs and/or Medicare EOBs that are unclear and/or have been reduced to a print much smaller than the original document. This is causing issues with reading the information in order to process the claims correctly. Please ensure that you are following required guidelines to ensure that TPL and Medicare claims are handled properly and efficiently:

  • EOBs must be clean, clear copies of the original EOB.

  • If unusual circumstances occur where it is necessary to reduce the size of the EOB, the information must still be large enough and clear enough to easily read.

  • The explanation page for payment/denial codes must be included, and any remarks/comments from the insurance company must be attached and legible.

  • An EOB must be attached to each claim form when multiple claims are sent.

  • Providers must submit EOBs with all the needed information. Claim status printouts or copies of payment registers from the primary payer will not be acceptable if they do not contain and clearly display all the required information/codes/descriptions for Medicaid to process the claim. These claims will be rejected without entering the system if the required information is not present.

Please use these guidelines when sending TPL claims and when it is necessary to submit a paper claim to Medicaid for processing a Medicare Crossover claim. Remember, paper Medicare Crossover claims should be submitted ONLY when the claim does not cross electronically from Medicare.

Attention Providers Billing Private Insurance TPL Claims Electronically For Legacy and Shared Health Plan

DHH would like to remind providers that Louisiana Medicaid will accept and process shared plans and legacy private insurance TPL claims submitted electronically. It is not necessary for providers to submit TPL claims hard copy with primary insurance EOBs attached. But many providers do not take advantage of this option. Submitting claims electronically leads to faster payments and increased cash flow.

Providers must enter the appropriate and accurate information from the primary payer's EOB to transmit electronically to Louisiana Medicaid for processing and payment. Detailed information concerning correct entry of TPL data in the 837 electronic specifications may be found in the Companion Guide(s) located on the Louisiana Medicaid web site, directory link "HIPAA Information Center". Providers must choose the appropriate Companion Guide applicable to the 837 transaction that will be submitted.

Claims denied by the TPL carrier must be reconciled with the carrier before the claim is submitted to Medicaid for processing. Providers may contact the Molina EDI Department at 225/216-6303 with questions concerning EDI transmissions.


Claims identified as a result of an internal audit revealed that detail dental claim lines were inappropriately paid at the Medicaid fee for service rate in addition to the encounter rate. Detail lines are to be paid at $0 and are only to be submitted to document the service provided. The inappropriately paid claims have been identified and will be recycled and appear on the RA of 10/7/14.

We apologize for any inconvenience that this error has caused.

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid:

Effective October 8, 2014, approved diagnosis codes for antipsychotic medication pharmacy claims have been expanded Please refer to for specifics.