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.
ATTENTION: Eligible Providers
Hurry! If you don’t begin participation in the Medicaid Electronic Health Records Incentive Program by December 31, 2016, you’ll miss out on $63,750 in incentive payments. Please visit the website at http://new.dhh.louisiana.gov/index.cfm/page/1159 for information. A new redesigned web portal will be ready for attestations starting September 19, 2016 at https://LAConnect.ThinkHTS.com. If you need additional information, please contact Kelli Douglas at 225-342-7742 or Gary Dillon at 225-342-4810.
Attention Providers of Breast Reconstruction Surgery
Providers were recently notified that, effective October 1, 2016, Louisiana Medicaid will now cover breast reconstruction post mastectomy of both the effected and contralateral breast for recipients diagnosed with breast cancer.
These procedures must be prior authorized.
It is the responsibility of the primary surgeon to obtain the prior authorization and use the assigned prior authorization (PA) number on his/her claim for the services. Related claims for the facility (hospital or ambulatory surgery center) and the assist surgeon when appropriate will not require a PA number to be present on the claim; however, these claims will pend to Medical Review for confirmation of PA. If the surgeon did not obtain the required PA (i.e., the approved authorization for the procedure isn’t present in the system), the claims for the hospital/ambulatory surgery center and assistant surgeon will be denied.
Questions concerning Medicaid fee for service prior authorizations may be directed to Molina Prior Authorization Unit at (800-488-6334 or 225-928-5263).
Questions concerning the authorization of services through a Healthy Louisiana Managed Care Organization (MCO) must be directed to the appropriate MCO.
Attention Fee for Service (FFS) Louisiana Medicaid Providers:
Effective October 19, 2016, Fee-for-Service (FFS) Medicaid Pharmacy Program will implement a copay exemption for select Preventive Care medications under certain criteria for eligible recipients at Point of Sale (POS). The select Preventive Care medicatons include aspirin, vitamin D 400 IU, folic acid, tamoxifen, raloxifene, tobacco cessation pharmacotherapy, oral fluoride supplements, and erythromycin eye ointment. For more information, please refer to www.lamedicaid.com.