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.

New Louisiana Department of Health and Hospitals Adverse Actions Web Search:

As a condition of participation in the Louisiana Medicaid Program, providers are responsible for ensuring current and potential employees, contractors and other agents and affiliates have not been excluded from participation in the Medicaid, or Medicare Program by Louisiana Medicaid, or the Department of Health and Human Services' Office of Inspector General. Providers who employ or contract with excluded individuals or entities may be subject to penalties of $10,000 for each item or services the excluded individual or entity furnished.

Providers have been previously instructed to check the websites of the Department of Health and Human Services' Office of Inspector General at http://exclusions.oig.hhs.gov and the System for Award Management (SAM) website at https://sam.gov/portal/SAM#1 for any exclusion imposed at the federal level upon hire and monthly thereafter for employees and/or subcontractors that perform services that are compensated with Medicaid/Medicare funds. Please be reminded that the SAM site is only for entities, and providers do not need to check employees on the SAM site.

Effective immediately, providers should check the Louisiana Department of Health and Hospitals Adverse Actions website at https://adverseactions.dhh.la.gov upon hire and monthly thereafter for individuals and entities that have had adverse actions imposed. This is a user friendly site that allows single and multiple searches of individuals and entities. The user may also choose to export the database and have it available in an Excel spreadsheet. Providers are required to maintain proof in their records that checks were done for employees and/or subcontractors. This may be done by printing out the result of the search.

All current and previous names used such as first, middle, maiden, married or hyphenated names and aliases for all owners, employees and contractors should be checked. If an individual's or entity's name appears on these websites, this person or entity is considered excluded and is barred from working with Medicare and/or the Louisiana Medicaid Program in any capacity. If the exclusion is learned prior to employment the provider should not employ the person or entity. If the provider learns of the exclusion after hiring the provider must notify the Department of Health and Hospitals within ten working days of discovering the exclusion with the following information:

  • Name of the excluded individual or entity and

  • Status of the individual or entity (applicant or employee/contractor).

If the individual or entity is an employee or contractor, the provider should also include the following information:

  • Beginning and ending dates of the individual's or entity's employment or contract with the agency,

  • Documentation of termination of employment or contract, and

  • Type of service(s) provided by the excluded individual or entity.

These findings should be reported to:

DHH.Medicaid.State.Exclusion@la.gov or

Department of Health and Hospitals
Program Integrity
P.O. Box 91030
Baton Rouge, LA 70821-9030

This new adverse actions web search tool does not replace the Nurse Aide Registry/Direct Service Worker Registry found at www.labenfa.com. Providers that employee Certified Nursing Assistants (CNA) and Direct Service Workers (DSW) are still required to check these registries upon hire and every six months thereafter.

These requirements are identified in the Provider Enrollment Agreements, the Medical Assistance Program Integrity Law (MAPIL) cited as Louisiana Revised Statute 46:437, referenced in the Louisiana Administrative Code (LAC) Title 50 and the Code of Federal Regulations 42 CFR § 455.436.

All excluded individuals must request reinstatement after the minimum excluded period has been served. There is no automatic reinstatement at either the federal or state level.

ATTENTION LOUISIANA APPLIED BEHAVOIR ANALYSIS PROVIDERS

H2019/H2019HM are both to be used to provide one on one ABA services to Medicaid clients. Under the current constraints of the Medicaid ABA program group therapy is not to be provided.

If you have questions or concerns, please contact Rene' Huff at (225) 342-3935 or rene.huff@la.gov

ATTENTION HOSPITAL PROVIDERS
CORRECTION TO HOSPITAL INPATIENT CLAIMS DENIED WITH EDIT 048

An error occurred in processing inpatient hospital claims that included an ICD-9 surgical procedure(s). These claims were incorrectly denied on the RAs of 10/21/14 and 10/28/14 with edit 048 (Missing/Invalid Surgical Procedure Code). This error has been corrected and the denied claims are being recycled on the RA of 10/28/14. Provider may see claims that were submitted from 10/17/14 - 10/23/14 listed as both denied and paid on the RA of 10/28/14. We apologize for any inconvenience this has caused.

For questions related to this information, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.

Attention Nursing Home Providers

The provider fee for ICF/DD providers was recently increased by $1.85. Subsequently, the Medicaid rates for the ICF/DD providers also increased by $1.85 as a "pass thru" for this increase. While implementing these changes, the nursing home payments for leave days were inadvertently increased by $1.85 in error. Molina is aware of the issue and are working to correct their system. They plan to re-cycle all affected nursing homes claims with a target date of 11/11/14. Providers will not have to do anything. We apologize for this error and if you have any questions, please call Lana Ryland at 225-342-9488 or lana.ryland@la.gov.

ATTENTION: LTC, ICF-DD, HOSPICE (ROOM & BOARD) and ADULT DAY HEALTH CARE FACILITIES

On the RA dated 10/09/2014, duplicate payments were made to some of the Nursing Home, ICF-DD, Hospice (Room & Board) and Adult Day Health Care facilities. Those duplicate payments are being systematically voided and will show as voided claims on the RA dated 11/10/2014. Some providers may have already submitted voids and these will not be included in the system recovery. We apologize for any inconvenience.

For questions related to this information, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.

Attention: Providers/Submitters of Electronic Claims---November and December 2014 Holiday Cut-off Dates for Receiving Electronic Claim Files

The cut-off dates/times for receiving electronic claim/encounter transactions at Molina for processing for the week prior and the week of Thanksgiving, Christmas and New Year's holidays are as follows:

Note: All times listed below are Central Standard Time.
Thursday November 20, 2014 at Noon
Wednesday November 26, 2014 at 11:00AM
Thursday December 18, 2014 at Noon
Wednesday December 24, 2014 at 10:00AM
Wednesday December 31, 2014 at 10:00AM

No files will be processed on either Thanksgiving Day November 27th, Christmas Day December 25th or New Year's Day January 1st.

For questions related to this information, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.