RA Messages for November 19, 2013


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.

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.


DHH has extended the deadline to submit a Medicaid Primary Care Services Designated Physician form and receive an effective date for enhanced reimbursement retrospective to January 1, 2013. In previous guidance, the deadline was June 28, 2013. The final deadline is now December 31, 2013. If your complete and correct form is received after December 31, 2013, you will receive enhanced reimbursement for eligible services rendered on or after the date the form is received.

For more information on the enhanced reimbursement, see the "ATTENTION PRIMARY CARE PROVIDERS: Affordable Care Act Enhanced Reimbursement of Primary Care Services Informational Bulletin" posted on www.lamedicaid.com.

Allergy Testing Update

The daily maximum units for billing allergy testing (CPT code 95017-'Allergy testing...with venoms...specify number of tests') has been updated to 30 in the legacy Medicaid claims processing system. This update is intended to accommodate variances in clinically appropriate and medically necessary testing. This change is effective for dates of service beginning January 1, 2013. Providers whose claims were processed by Molina and were denied due to the previous 15 unit daily limit may resubmit those claims.

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