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 ALL PROVIDERS
Molina is experiencing greater volumes of hard copy claims in which providers use of
liquid paper for corrections is causing the pages of the claims to stick together. This
practice creates two problems:
(1) The pages are not readable after being pulled apart; and
(2) Pages that are stuck together cause scanning equipment to jam.
Therefore, we request that providers not use liquid correction products to make
corrections on claims. Please use either a 'tape-type' product or mark through the error and rewrite the corrected information. All information on the claim form must be clear and readable in order for the claim to be processed correctly.
ATTENTION ALL PROVIDERS SUBMITTING FEE FOR SERVICE
LOUISIANA MEDICAID CLAIMS TO MOLINA
Louisiana Medicaid's 7-digit provider number is required on all claim forms. Each week, Molina rejects and returns paper claims because the 7-digit Louisiana Medicaid provider number is not present on the claim form in the appropriate field. Providers must be
enrolled in Louisiana Medicaid and receive a 7-digit provider number in order to bill
services to Louisiana Medicaid. If you are an enrolled provider, please ensure the
Louisiana Medicaid Provider number is on the claims before mailing. If you are a
provider not enrolled in Louisiana Medicaid (whether in-or out-of-state) and you have
provided services to a Louisiana Medicaid recipient, you must enroll as a Louisiana
Medicaid provider in order to be reimbursed for services rendered.
ATTENTION ALL PROVIDERS
RESUBMISSION OF PAPER CLAIMS TO MOLINA FOR BAYOU HEALTH
SHARED PLAN (UHC OR CHS) MEMBERS
Shared Plan claims received by Molina after the initial one year timely filing limit cannot be processed unless the provider is able to furnish the Shared Plans EOB or Payment
Register showing the original claim was filed timely. Molina has received Shared Plan claims where only the private insurance EOB is attached and no Shared Plan EOB or Molina EOB is present. A private insurance EOB does not support proof of timely filing with Medicaid. All outstanding claims over 1 year old must be submitted with either the Shared Plan or Molina EOB indicating proof of timely filing. If a situation involves private insurance, that TPL EOB must also be submitted with the claim, however, it does not replace the EOB required from either the Shared Plan or Molina in providing proof of filing.
Update to ‘ClaimCheck’ Product Editing
McKesson’s ‘ClaimCheck’ product is routinely updated by the McKesson Corporation based on changes made to the resources used, such as Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) coding guidelines, the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule Database, CMS National Correct Coding Initiative (NCCI) and/or provider specialty society updates. The ‘ClaimCheck’ product’s procedure code edits are guided by these widely accepted industry standards.
These edit changes went into effect for claims processed beginning with the remittance advice of October 6, 2015. Providers may notice some differences in claims editing; however, most claims will continue to edit in the same manner, but when applicable, claims may now pay or deny for a different reason.
For questions related to this information as it pertains to Legacy Medicaid claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.
Attention "Local" Medicaid Pharmacy Providers:
Effective December 1, 2015, the Department of Health and Hospitals will initiate a Managed Care Organization (MCO) claims reimbursement dispute process for "local" pharmacies in accordance with Act 399 of the 2015 Regular Legislative Session. Please see http://www.lamedicaid.com/provweb1/Pharmacy/pharmacyindex.htm
for more information.
ATTENTION PROVIDERS AND SUBMITTERS OF ELECTRONIC CLAIMS
The deadline for receiving the 2016 Annual Certification Forms is December 31, 2015. If you have not submitted a Certification Form for your submitter number (beginning with 450), immediate action is required. Submitters who do not submit the required form will be deactivated February 1, 2016. Providers should verify with their submitter that this requirement has been met to ensure no delays in claims payment.
Submitters must mail the Annual Certification Forms to Molina at the following address:
Molina Medicaid Solutions - EDI Department
PO Box 91025
Baton Rouge, LA 70821-9025
The form can be found here: 2016 EDI Certification Form.
ATTENTION DENTAL - ORAL SURGEON - PROVIDERS
CORRECTION to 12/1/2015 Remittance Advice
DHH has identified Dental Services claims (for Provider Type 27-Dentist; Provider Specialty 67-0ral Surgeon) that were inappropriately paid by fee-for-service Medicaid beginning with date of service 2/1/2015. These claims became the responsibility of the Managed Care Organizations (MCOs) effective 2/1/2015. These claims were to be voided on the RA of 12/01/15. The voids did not occur for that RA and, therefore, they will appear on the Remittance Advice or 12/08/2015. Molina will void these inappropriately paid claims with edit 507 - submit claim to BYU Health Plan, and they will carry ICN Julian day 5333. Providers arc required to verify linkage thru eMEVS or REVS and submit these claims to the recipients' MCO for payment.
Should you have questions related to the voids, please contact Molina Providers Relations at 1-800-473-2783. Questions regarding submission of claims to/payment by the correct entity should be directed to the member's MCO.