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 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 ALL PROVIDERS
The diagnosis code 3051 (Tobacco Use Disorder) will be paid under Medicaid Managed Care (Bayou Health) for health
plan recipients and by Molina for legacy Medicaid recipients. This diagnosis is not paid under LBHP through
Magellan. Claims will be recycled on the 11/22/13 RA.
Please submit claims with a primary diagnosis of 3051 to the appropriate Bayou Health Plan or Molina for
processing. Please refer to the Informational Bulletin 12-18 at www.makingmedicaidbetter.com for the complete
list of behavioral health Diagnosis Codes that are excluded from payment by Magellan.
ATTENTION PCS PROVIDERS
CLAIMS DENIED IN ERROR DUE TO PREPARATION FOR CHANGES IN SERVICE LIMITS
In preparation for service limit changes for LT-PCS, logic was altered prior to notifying providers of these
changes. Starting with the RA of 10/8/13, claims processed for LT-PCS services for T1019 UB, T1019 UN, and
T1019 UP with daily units greater than 32 and less than 47 denied with edit 542 (units exceed maximum daily
allowed limit). This logic change is being reversed to put the educational edit 543 (units paid between 33
and 47) back in place temporarily and denied claims are being recycled. No action is required by providers.
Please monitor RA messages and the web site for additional upcoming information concerning these service limit
For questions related to this notification, please contact Molina Medicaid Solutions Provider Services at (800)
473-2783 or (225) 924-5040.
Revised status on LTC/ICF-DD Adjustments and Voids scheduled for the 10/29/2013 checkwrite
Molina generated adjustments and voids originally scheduled for processing for the October 29, 2013
have been re-scheduled for processing on the November 5th, 2013 checkwrite. Please be aware that this
in no way delays or defers the processing of provider-submitted adjustments/voids on payments. For
questions or concerns regarding this notification, please contact Molina Medicaid Solutions Provider
Services at (800) 473-2783 or (225) 924-5040.
NCCI Changes to Preventive Care/Immunization Administration Billing Effective January 2014
Effective January 2014, there are changes to CMS's National Correct Coding Initiative
(NCCI) billing guidance: Providers are directed to the Louisiana Medicaid homepage,
(www.lamedicaid.com/) for details on new CMS directives
when billing for preventive care and immunization administration codes on the same date of service.