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 HOSPITAL PROVIDERS:
POLICY CLARIFICATION- HOSPITAL OWNED CLINICS AND PROVIDER BASED BILLING

In late June, a notice was published to hospitals addressing the appropriate use of Revenue Code 761 and claims related to the issues identified in the notice were systematically voided. Since that notice, we have received inquiries from several hospitals concerning services provided at hospital ‘satellite’ locations and the use of HR761. Medicaid has issued a policy clarification statement to assist providers with understanding Medicaid policy for hospital satellite locations/clinics and provider based billing. This statement is available in its entirety for all providers via web posting on the LaMedicaid.com homepage.

Please contact Molina Provider Relations (800) 473-2783 or (225) 924-5040 if you have any questions regarding this matter.

Attention Fee for Service (FFS) Louisiana Medicaid Providers:

Effective November 17, 2015, clinical pre-authorization will be required on pharmacy claims for all behavioral health medication prescriptions for recipients <6 years old. Please refer to www.lamedicaid.com for specifics.

Attention Fee for Service (FFS) Louisiana Medicaid Providers:

Effective November 17, 2015, the La. Medicaid FFS Pharmacy Program has implemented a new maximum dosage for Saphris® and a new diagnosis for Humira® . Please refer to www.lamedicaid.com for specifics.

ATTENTION WAIVER AND PCS PROVIDERS
AUDIT PAYOUTS
FOR CLAIMS THAT WERE UNDERPAID ON THE 11/10/15 RA

During the systematic recycle of Waiver and PCS claims that were denied in error on the 11/3/15 RA, some claims pending for pre-payment review were not captured and were underpaid on this week’s RA (11/10/15). Those claims have been identified and an audit payout is being done to pay providers the additional amounts owed on these claims. This check write will be dated Wednesday, 11/11/15 with EFT deposits occurring on Thursday, 11/12/15 or Friday, 11/13/15 depending on the Provider’s bank. A special RA dated 11/11/15 will be posted for providers.

An audit recovery will be created on the 11/17/15 check write to offset the audit payout and those claims that were used to create the audit payout will be adjusted.

No action is required by providers and we apologize for any inconvenience this has caused.