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 for information. A new redesigned web portal will be ready for attestations starting September 19, 2016 at 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, 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.

Attention Professional Providers, Independent Laboratory Providers, Take Charge Plus Providers and Outpatient Hospital Providers
Papanicolaou test (Pap Test)

The American Congress of Obstetricians and Gynecologists guidelines (ACOG) does not recommend cervical cancer screening of women younger than 21 years of age. Effective with dates of service January 1, 2017 and forward, Medicaid will no longer reimburse for routine cervical cancer screening for recipients under the age of 21 years.

However, Medicaid considers cervical cancer screening medically necessary for recipients under age 21 who were exposed to diethylstilbestrol before birth, have human immunodeficiency virus, a weakened immune system, a history of cervical cancer, or other criteria subsequently published by ACOG.

Providers of these laboratory services must submit supporting documentation to the fiscal intermediary to have the age restriction bypassed for a specific clinical situation. It is the responsibility of the treating provider to provide the required documentation needed for billing purposes to the laboratory provider upon request.

Further instructions will follow for Medicaid fee for service claims submission when recipients are younger than age 21 and meet the criteria for coverage.

Updates to Healthy Louisiana related systems and claims processing are plan specific and are the responsibility of each health plan. For questions regarding Healthy Louisiana updates, please contact the appropriate health plan. In addition, questions regarding legacy Medicaid should be directed to Molina Provider Relations at 1(800) 473-2783 or (225) 924-5040.

Attention Fee for Service (FFS) Louisiana Medicaid Providers:

Effective January 10, 2017 FFS pharmacy program in conjunction with the Louisiana Drug Utilization (DUR) Board has revised quantity limits for selected opioid products. Selected products will be limited to a certain number of units per 15 days supply within a 30 day period. For more information, please refer to