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: Provider Portal Login Update on LAMEDICAID.com

On Friday September 21, 2018, Molina will install an enhanced version of its provider portal on LAMEDICAID.com in partnership with the Louisiana Department of Health. With your first login, you will be required to update your password, profile, and answer three security questions. Please take this opportunity to update your user information such as email address and phone number. For security purposes, the Provider Applications page has been simplified to display applications based on information such as provider type, specialty, and enrollment status.

ATTENTION: ICF/IID FACILITIES

The USC, CFR, and La Medicaid State Plan require that the claim. defined as a single document line identifying the services and/or charges for services for a single recipient from a single provider, be submitted to Louisiana Medicaid for payment within 12 months from the date of service and that the claim be paid no later than 12 months from the date of receipt of the claim. Failure to bill within the allotted period will result in the nonpayment of claims.

In addition, the Louisiana Department of Health strongly encourages providers to bill monthly and to attempt to clear any denials received within two billing periods.

Physician-Administered Drugs - Reimbursement Changes

The U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) has mandated that Louisiana Medicaid revise the reimbursement methodology for physician-administered drugs in a physician office setting. This revision will update current reimbursement rates and will provide a mechanism for annual updates to the rates.

Effective for dates of service on and after July 1, 2018, Louisiana Medicaid adjusted the reimbursement rates on the fee-for-service (FFS) file for physician-administered drugs and payable vaccines in the physician office setting. The procedure codes for physician-administered drugs are typically listed as a Healthcare Common Procedure Coding System (HCPCS) procedure code beginning with “J” and payable vaccines by the relevant CPT code. Claims previously submitted for physician-administered drugs or vaccines with dates of service on or after July 1, 2018 will be systematically adjusted in the upcoming weeks to ensure proper payment. No action is required by the provider.

Going forward, updates to the reimbursement rates for physician-administered drugs and payable vaccines will occur annually at the beginning of each year as part of the annual Healthcare Common Procedure Coding System (HCPCS) process.

The rate changes are reflected on the Professional Services, Take Charge Plus and applicable Immunization fee schedules.

Please contact DXC Provider Relations at (800) 473-2783 or (225) 924-5040 if there are questions related to this matter for fee for service claims. Questions related to the Healthy Louisiana managed care organizations' updates should be directed to the specific health plan.

Attention Louisiana Medicaid Providers:

Effective October 17, 2018, the Louisiana Medicaid Fee for Service (FFS) Pharmacy Program will implement a Clinical Pre-Authorization requirement for pyrimethamine (Daraprim®). Please refer to www.lamedicaid.com for more information.