RA Messages for December 26, 2012


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.


ATTENTION PRIMARY CARE PROVIDERS

The Affordable Care Act requires Medicaid to reimburse designated physicians for specified primary care services rendered during calendar years 2013 and 2014 at an enhanced rate. For more information on this enhanced reimbursement and what physicians must do to receive it, visit http://www.lamedicaid.com/


ATTENTION PROVIDERS:

Providers who submitted claims for claim type 14 and 15 for the period of 3/1/2012 forward, for those individuals who are in populations that are excluded from the LBHP program and that originally denied for edit 555 (submit claim to LBHP SMO), those claims are being recycled for either payment or denial for the correct edit by Molina on the RA of 12/18/12. We apologize for any inconvenience that this may have caused providers.


ATTENTION PROVIDERS:

Providers who submitted claims for claim types 01, 04, 14 and 15 for the period of 3/1/12 forward for those individuals who are in populations that are excluded from the LBHP program, with a diagnosis of specialized behavioral health, and that originally denied for edit 555 (submit claim to LBHP SMO), are recycled for payment by Molina on the RA of 12/10/12. We apologize for any inconvenience that this may have caused providers.


ATTENTION ALL PROVIDERS
HOLIDAY CHECKWRITE DATES ADJUSTED

Due to the State, Federal and Bank Holiday schedules, the checkwrite dates for the last week in December and the first week in January will be adjusted to Wednesday, December 26, 2012, and Wednesday, January 2, 2013. EFTs will be released on December 27th and January 3rd.

Reminder: The EDI cutoffs for these weeks are Thursday, 12/20/12, at noon for the December 26th checkwrite and Thursday, 12/27/12, at noon for the January 2nd checkwrite.


ATTENTION HOSPITAL PROVIDERS: EFFECTIVE 12/14/12 MOTHER'S MEDICAID NUMBER REQUIRED FOR INITIAL PRECERT
OF LEGACY NEWBORNS

DHH is requesting that in order for Providers to begin the Precert process, initial newborn requests submitted to Legacy Medicaid will require the mother's Medicaid number to be included on the PCF01 form. The 13 digit Medicaid number area on the PCF01should remain as all zeros until the baby's Medicaid number is assigned. If submitting electronically through ePrecert, the mother's number should be typed in the text box area.

These requests will be rejected if the Provider fails to provide this information or if the mother is verified as having Bayou Health Plan coverage on the day of admit. Please visit www.lamedicaid.com
for the notice. If you have any questions please contact Molina Provider Relations (800) 473-2783 or (225) 924-5040.