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: 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.
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.
Attention Louisiana Medicaid Providers:
Effective October 24, 2018, the Louisiana Medicaid Fee for Service (FFS) Pharmacy Program will implement Point of Sale (POS) quantity limits for epinephrine injection
(Generic, EpiPen®, and EpiPen Jr®). Please refer to www.lamedicaid.com for more information.
Attention Providers - Claims Adjustment/Recycle
Reimbursement Changes for Physician-Administered Drugs
Louisiana Medicaid has recently revised the reimbursement methodology for physician-administered drugs in a physician office setting effective with dates of service July 1, 2018 forward.
Fee-for-service (FFS) claims previously processed and paid for physician-administered drugs (J-codes) or payable vaccines beginning with a July 1, 2018 date of service have been adjusted/recycled as appropriate based on the updated reimbursement rate. Providers can expect to see the results of this process on the remittance advice of October 23, 2018. Crossover claims impacted by this change will be addressed separately in the near future.
This action will affect Professional Services, Take Charge Plus and applicable Immunization claims.
Please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040 if there are questions related to this matter for FFS claims. Questions related to the Healthy Louisiana managed care organizations' updates should be directed to the specific health plan.