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 PROVIDERS
PAYMENT ERROR RATE MEASUREMENT (PERM) 2017 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, CNI Advantage.

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: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/PERM/Providers.html.

ATTENTION PROVIDERS OF IMMUNIZATION SERVICES:

An update to the fee for service claims processing system related to the processing and payment of immunization claims has been completed. Affected claims will be recycled for payment or denied for the correct edit without any action on behalf of the provider. The recycle will be included on the RA of Tuesday, October 31st, 2017.

For questions regarding this message and/or fee for service claims, please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040.

Updates to Healthy Louisiana related systems and claims processing changes are plan specific and are the responsibility of each health plan. For questions regarding Healthy Louisiana updates, please contact the appropriate health plan.

ATTENTION PROVIDERS OF End Stage Renal Disease SERVICES:

Effective immediately, Louisiana Medicaid has updated the units of service on the fee for service procedure file for Healthcare Common Procedure Coding System (HCPC) code J1756-Injection, iron sucrose, 1 mg to align with the recommended dosage.

For questions regarding this message and/or fee for service claims, please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040.

Updates to Healthy Louisiana related systems and claims processing changes are plan specific and are the responsibility of each health plan. For questions regarding Healthy Louisiana updates, please contact the appropriate health plan.

ATTENTION PROVIDERS OF IMMUNIZATION SERVICES:

Louisiana Medicaid has added coverage of Current Procedural Terminology (CPT) code 90674-Influenza vaccine, quadrivalent, preservative and antibiotic free, 0.5 ml, for IM use, to include recipients aged 19 years and older effective October 1, 2017. Providers that have received denied claims for dates of service beginning October 1st 2017, may resubmit their claims for payment as appropriate.

For questions regarding this message and/or fee for service claims, please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040.

Updates to Healthy Louisiana related systems and claims processing changes are plan specific and are the responsibility of each health plan. For questions regarding Healthy Louisiana updates, please contact the appropriate health plan.