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.
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.
ATTENTION EPSDT PROVIDERS
Louisiana Medicaid has updated the EPSDT Periodicity Schedule to closely align with the current American
Academy of Pediatrics (AAP) Bright Futures "Recommendations for Preventive Pediatric Health Care" schedule
(copyright 2008). Providers may download a PDF version at www.lamedicaid.com under the link for
Training/2013 Policy Updates/Professional Services Program. The updated EPSDT Periodicity schedule is
effective immediately.
Notable changes from the previous Louisiana Medicaid EPSDT periodicity schedule include:
- The objective vision screening, procedure code 99173-EP, now begins at age three.
- Preventive care services for adolescents are now expected to be performed annually. This change
reflects the Department's goal to increase the number of annual preventive services in this age group and
focus on adolescent health and improving health outcomes related to the adolescent population.
- Please note that Louisiana Medicaid does not require the "3-5 day" visit listed currently on the "AAP
website schedule." Those services are typically performed while the infant is in the hospital and are not
required to be duplicated.
If you have any questions please contact Molina Provider Relations (800) 473-2783 or (225) 924-5040.
ATTENTION PROVIDERS OF INFLUENZA VACCINE
As part of the 2013 CPT update, a new influenza vaccine code, 90672 (Influenza virus vaccine....for intranasal
use), was made available to providers on or after January 1, 2013. CPT code 90672 has been added
to the Immunization fee schedule. Please note that procedure code 90672 can only be submitted with
immunization administration codes 90473 or 90474. Medicaid will pay for the nasal administration of this
vaccine. The vaccine code 90672 is to be submitted with a "zero" dollar amount as it is a part of the
Vaccines for Children program provided at no cost to providers.
Molina has identified and recycled all claims for the new vaccine procedure code and the associated codes
for the administration of the vaccine. These claims were recycled on the 11/05/13 RA and no action is
needed by the providers.
If you have any questions please contact Molina Provider Relations (800) 473-2783 or (225) 924-5040.