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.
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 www.lamedicaid.com.