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
Should you have any questions
regarding any of the following messages, please contact Molina Medicaid
Solutions at (800) 473-2783 or (225) 924-5040.
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 CLIA Waived Tests
CMS mandated Clinical Laboratory Improvement Amendments (CLIA) claim edits are applied to all laboratory services billed on fee for service claims. Claims submitted that do not meet the required CLIA criteria will deny.
Providers with waiver or provider-performed microscopy (PPM) certificate types may be paid only for those waiver and/or PPM codes approved for their certification types. Providers with these certification types are to add the 'QW' modifier to the procedure code for all applicable CLIA waived or PPM tests they submit for reimbursement.
Please note that the fee for service claims processing system has been updated to assure correct processing of claims for laboratory services.
Effective for claims processed on or after August 21, 2017 Current Procedural Terminology (CPT) codes 87338 and 87361 will require a “QW” modifier when submitted.
Additional CLIA information can be found in the Professional Services Provider Manual, please refer to Appendix A.
For questions related to this information as it pertains to fee for service Medicaid claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.
Questions related to Healthy Louisiana managed care organizations’ updates should be directed to the specific health plan.
ATTENTION: LTC and ICF-DD FACILITIES
Beginning March 2018, monthly Optional State Supplement (OSS) payments will be generated by State of Louisiana Division of Administration.
To receive OSS payments for eligible residents of Long Term Care and ICF-DD Facilities after February 2018, the Facility must complete the following no later than January 12, 2018:
- Register as a Vendor with Louisiana Division of Administration @ http://www.doa.la.gov/pages/osp/vendorcenter/vendorregn.aspx
- Submit a completed IRS W-9 form for the Facility to DOA-OSRAP, via e-mail at DOA-OSRAP-LAGOV@LA.GOV or fax (225) 342-0960.
If you need help with LAGOV registration, contact Office of State Procurement via email VENDR_INQ@la.gov or phone 225-342-8010.
Providers must continue to review the OSS Payment Remittances through the OSS web application in order to verify and issue individual recipient payments.
Return Payments must be made through the OSS system. Payments should not be returned to Louisiana Department of Health.
Refer to the OSS Provider User Guide located on the “Forms/Files/Surveys/User Manuals” tab at LaMedicaid.com for additional information.
For questions related to this announcement, email to OSS@la.gov; or contact LDH’s OSS Program Manager, Lorie Young, by phone at (225) 342-0456.