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.
ATTENTION: Eligible Providers
Hurry! If you don’t begin participation in the Medicaid Electronic Health Records Incentive Program by December 31, 2016, you’ll miss out on $63,750 in incentive payments. Please visit the website at http://new.dhh.louisiana.gov/index.cfm/page/1159 for information. A new redesigned web portal will be ready for attestations starting September 19, 2016 at https://LAConnect.ThinkHTS.com. If you need additional information, please contact Kelli Douglas at 225-342-7742 or Gary Dillon at 225-342-4810.
VFC Providers: Coverage of HPV Vaccine, CPT Code 90651
Louisiana Medicaid has become aware of an issue related to the Vaccines for Children (VFC) vaccine listing for CPT code 90651, (Human Papilloma Virus vaccine… (9vHPV)…), on the Immunization Fee Schedule for “Children/Adolescents”.
In January of 2016, due to an inadvertent omission from the listing of VFC vaccines Medicaid received, CPT code 90651 was removed from the “Children/Adolescents” Immunization Fee Schedule. It has remained correctly listed on the “Young Adult” and “Adult” immunization fee schedules.
This vaccine should have remained on the “Children/Adolescents” listing as payable at $0.00 like other VFC provided vaccines. The effective date of service for inclusion on this fee schedule is on or after May 1, 2015 and the vaccine administration fee for this vaccine is therefore payable from that date forward. The “Children/Adolescents” fee schedules for 2016 are being updated on the Medicaid website, www.lamedicaid.com to correct the omission.
Healthy Louisiana managed care plans have been directed to identify claims that may have denied due to this situation and reprocess them for correct payment of the vaccine administration and inclusion of the vaccine in details needed for federal and other reporting of vaccine information. Fee for service Medicaid claims that denied inappropriately will be reprocessed with no action required by the provider.
Questions concerning Healthy Louisiana managed care organization (MCO) processes are to be directed to the appropriate MCO. Those questions related to Medicaid fee for service claims should be directed to Molina Provider Relations at (800) 473-2783 or (225) 924-5040.