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.


Louisiana Medicaid has been in communication with the Office of Population Affairs (OPA) concerning the upcoming expiration date (October 31, 2015) on the current Sterilization Consent Form (HHS 687). OPA is in the process of requesting approval from Health and Human Services (HHS) for an extension of the current form as there are no planned revisions to the language used in the current form. Molina will continue to accept the current form until OPA publishes the form with an updated expiration date. Once the update occurs, an RA message will be published letting providers know how long the prior form will be accepted by Molina.

Please contact Molina Provider Relations (800) 473-2783 or (225) 924-5040 if you have any questions regarding this matter.

Attention Pharmacists of Louisiana Medicaid Fee for Service:

Molina is in the process of updating their system to accept the February 2013 version of the NCPDP paper claim form. The system will be ready within the next six weeks. Please NOTE that once the system is ready to receive the latest NCPDP form, a second notice will be sent to providers outlining a grace period for accepting any older versions of the paper pharmacy form. Billing information and a sample copy of the 02/2013 NCPDP form is available to view at


For Demonstration Year 5 covering time period, 10/1/2014 - 9/30/2015, providers must submit claims for processing no later than 11/14/2015. Claims submitted after this date will not be approved. Claims must be postmarked no later than 11/14/15 if mailed or may be delivered directly to Molina as long as they are received no later than 5 p.m. on Friday, 11/13/15. For paper claim submissions, please use a 9 x 12 envelope marked on the outside in large letters, "GNOCHC Claims".