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.
For information regarding the medication policy and/or criteria associated with this denial, providers
may access the Louisiana Medicaid Preferred Drug List (PDL) / Non-Preferred Drug List at
PAYMENT ERROR RATE MEASUREMENT (PERM) 2021 IS NOW IN PROGRESS
Louisiana Medicaid is mandated to participate in the Centers for Medicare and Medicaid (CMS) Payment Error Rate Measurement (PERM) program which will assess our payment accuracy rate for the Medicaid and CHIP programs. If chosen in a random sample, your organization will soon receive a Medical Records Request from the CMS review contractor, AdvanceMed. This cycle measurement will review Medicaid and CHIP payments made in Reporting Year (RY) 2021: July 1, 2019 through June 30, 2020.
Please be advised that sampled providers who fail to cooperate with the CMS contractor by established deadlines may be subject to sanctioning by Louisiana Medicaid Program Integrity through the imposition of a payment recovery by means of a withholding of payment until the overpayment is satisfied, and/or a fine.
Please be reminded that providers who are no longer doing business with Louisiana Medicaid are obligated to retain recipient records for 5 years, under the terms of the Provider Enrollment Agreement.
For more information about PERM and your role as a provider, please visit the Provider link on the CMS PERM website:
ESRD Facilities and Independent Laboratory:
Non-Routine Laboratory Services
Effective with date of service October 20, 2020, covered medically necessary non-routine laboratory services performed by approved Medicaid laboratories can be billed separately by either the contracted laboratory or by the dialysis facility. The ESRD facility and their contracted laboratory must coordinate billing to ensure duplicate payments do not occur.
Routine lab work continues to be an integral part of outpatient hemodialysis services and reimbursement for routine lab services is included in the dialysis reimbursement rate.
Information regarding this policy is forthcoming and will be found on
www.lamedicaid.com under the Provider Manuals link, within the End Stage Renal Disease Services manual.
Questions regarding this message and fee for service claims may be directed to Gainwell Technologies, Provider Relations at (800) 473-2783 or (225) 924-5040. Questions regarding managed care claims may be directed to the appropriate managed care organization.