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.

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.

Home Health New Bill Type (BT)

ATTENTION HOME HEALTH PROVIDERS - NEW BILL TYPE ACCEPTED: Effective immediately, claims processing logic has been changed to accept the new NUBC UB Bill Type 32X for Home Health claims with dates of service October 1, 2013 forward. Claims previously submitted with this new Bill Type and denied with edit 042 (Invalid Bill Type) will be recycled on the 11/26/13 RA. Also, please remember that Home Health claims submitted electronically must be submitted with the file extension HOM. Claim files submitted without the HOM extension will be rejected for the Bill Type, because 32X is not an acceptable Bill Type for other institutional claims.

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

Attention: All Providers

Effective January 1, 2014, TPL Scope of Coverage Codes will be returned on all valid eligibility verification responses (271) from the MEVS, eMEVS, and batch MEVS for recipient that have private insurance on the service date requested.

This code information will appear in the response in the segment "Other or Additional Payor."

This code information is available to all providers at the following link: http://www.lamedicaid.com/provweb1/TPL_Coverage/TPL_Coverage.htm.

If you have questions, please call Jackie Porta at 225-342-9463. Thank you for your cooperation in this matter.

Attention: MEVS Vendors

Effective January 1, 2014, TPL Scope of Coverage Codes will be returned on all valid eligibility verification responses (271) from the Louisiana MEVS. The verification response will return the CODE only. The Scope of Coverage code will be included in the EB05 field as a 2-digit code. This Scope of Coverage code may be followed by a single space and a second 2-digit Scope of Coverage code. These codes are intended to be presented without interpretation to the inquiring provider. A list of the Scope of Coverage codes and descriptions is available to all providers at the following link:

http://www.lamedicaid.com/provweb1/TPL_Coverage/TPL_Coverage.htm.

The TPL Scope of Coverage Codes descriptions are:

00 Not Available
01 Major Medical
02 Medicare Supplement
03 Hospital, Physician, Dental and Drugs
04 Hospital, Physician, Dental
05 Hospital, Physician, Drugs
06 Hospital, Physician
07 Hospital, Dental and Drugs
08 Hospital, Dental
09 Hospital, Drugs
10 Hospital Only
11 Inpatient Hospital Only
12 Outpatient Hospital Only
13 Physician, Dental and Drugs
14 Physician and Dental
15 Physician and Drugs
16 Physician Only
17 Dental and Drugs Only
18 Dental Only
19 Drugs Only
20 Nursing Home Only
21 Cancer Only
22 CHAMPUS/CHAMPVA
23 Veterans Administration
24 Transportation
25 HMO
26 Carrier declared Bankruptcy
27 Major Medical without maternity benefits
28 HMO/Ins Paid by Medicaid GHIPP program
29 Skilled Nursing Care
30 Medicare HMO (Part C)
31 Physician Only HMO
32 Pharmacy (PBM)
33 HMO No Maternity

If you have questions, please call Jackie Porta at 225-342-9463. Thank you for your cooperation in this matter.