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.
For information regarding the medication policy and/or criteria associated with this denial, providers
may access the Louisiana Medicaid Preferred Drug List (PDL) / Non-Preferred Drug List at
PAYMENT ERROR RATE MEASUREMENT (PERM) 2021 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, AdvanceMed. This cycle measurement will review Medicaid and CHIP payments made in Reporting Year (RY) 2021: July 1, 2019 through June 30, 2020.
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:
CHANGES TO DME, HOME HEALTH, PEDIATRIC DAY HEALTH
CARE, REHABILITATION AND PERSONAL CARE SERVICES
DUE TO HURRICANE DELTA - OCTOBER 2020
On October 6, 2020 Governor John Bel Edwards declared a state of emergency ahead of Hurricane Delta as significant impact to the state of Louisiana is expected. This policy change is effective October 8, 2020 and shall only be applicable for beneficiaries residing in parishes that have instituted mandatory evacuations.
Medicaid beneficiaries who live in one of the parishes under mandatory evacuation, and who are in need of replacement equipment or supplies previously approved by Medicaid, may contact a Medicaid-enrolled durable medical equipment (DME) provider of their choice. Medicaid-enrolled providers must make a request to Gainwell Technologies’ Prior Authorization Unit; however, a new prescription and medical documentation are not required. The provider shall submit the required Prior Authorization Form (PA-01) along
with a signed letter from the recipient, giving a current place of residence and stating that the original equipment or supplies were lost due to Hurricane Delta.
Beneficiaries who were approved to receive medical equipment, supplies, home health services, rehabilitation, pediatric day health care or personal care services from a provider in a parish with a mandatory evacuation that is no longer in business or unable to provide the approved equipment, supplies or services may obtain the approved items or services from a new provider of their choice. The provider must be enrolled in Medicaid.
Gainwell Technologies shall provide any guidance to the provider on the cancelation of the original authorization and issuance of a new authorization, if applicable.
All other prior authorization requests shall continue to be subject to the applicable requirements to establish medical necessity.
Questions concerning Healthy Louisiana managed care organization processes are to be directed to the appropriate MCO. Those questions related to Medicaid fee-for-service claims should be directed to Gainwell Technologies Provider Relations at (800) 473-2783 or (225) 924-5040.