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.

ATTENTION PROVIDERS
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.

Attention Fee for Service (FFS) Louisiana Medicaid Providers:

Effective September 29, 2017, Fee-for-Service (FFS) Medicaid Pharmacy Program will require clinical pre-authorization for glecaprevir/pibrentasvir (Mavyret®). For more information, please refer to www.lamedicaid.com.

Attention Fee for Service (FFS) Louisiana Medicaid Providers:

Effective October 11, 2017, Fee-for-Service (FFS) Medicaid pharmacy claims will have Point of Sale (POS) edits for sumatriptan nasal powder (Onzetra®) and buprenorphine buccal film (Belbuca®). Please refer to www.lamedicaid.com for more information.

ATTENTION: LTC and ICF-DD FACILITIES

Beginning November 2017, monthly Optional State Supplement (OSS) payments will be generated by the State’s Fiscal Intermediary, Molina Medicaid Solutions, through LTC/ICF-DD providers’ existing Electronic Funds Transfer (EFT) information. The OSS payments will appear as a Financial Transaction Additional Payment line item. The PLB Loop in the 835 will reflect the OSS PAYMENT. The payments will not be included in providers’ 1099.

Providers must continue to review the OSS Payment Remittances through the OSS web application in order to verify and issue individual recipient payments.

Please be aware Return Payments must be made through the OSS system. Payments should not be returned to Louisiana Department of Health.

Refer to the OSS Provider User Guide located on the "Forms/Files/Surveys/User Manuals" tab at LaMedicaid.com for additional information.

For questions related to this announcement, email to OSS@la.gov; or contact LDH’s OSS Program Manager, Lorie Young, by phone at (225) 342-0456.