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.
New Louisiana Department of Health and Hospitals Adverse Actions Web Search:
As a condition of participation in the Louisiana Medicaid Program, providers are
responsible for ensuring current and potential employees, contractors and other
agents and affiliates have not been excluded from participation in the Medicaid,
or Medicare Program by Louisiana Medicaid, or the Department of Health and Human
Services' Office of Inspector General. Providers who employ or contract with
excluded individuals or entities may be subject to penalties of $10,000 for each
item or services the excluded individual or entity furnished.
Providers have been previously instructed to check the websites of the
Department of Health and Human Services' Office of Inspector General at
and the System for Award Management (SAM) website at
for any exclusion imposed at the federal level upon hire and monthly thereafter
for employees and/or subcontractors that perform services that are compensated
with Medicaid/Medicare funds. Please be reminded that the SAM site is only for
entities, and providers do not need to check employees on the SAM site.
Effective immediately, providers should check the Louisiana Department of Health
and Hospitals Adverse Actions website at
upon hire and monthly thereafter for individuals and entities that have had
adverse actions imposed. This is a user friendly site that allows single and
multiple searches of individuals and entities. The user may also choose to
export the database and have it available in an Excel spreadsheet. Providers are
required to maintain proof in their records that checks were done for employees
and/or subcontractors. This may be done by printing out the result of the
All current and previous names used such as first, middle, maiden, married or
hyphenated names and aliases for all owners, employees and contractors should be
checked. If an individual's or entity's name appears on these websites, this
person or entity is considered excluded and is barred from working with Medicare
and/or the Louisiana Medicaid Program in any capacity. If the exclusion is
learned prior to employment the provider should not employ the person or entity.
If the provider learns of the exclusion after hiring the provider must notify
the Department of Health and Hospitals within ten working days of discovering
the exclusion with the following information:
- Name of the excluded individual or entity and
- Status of the individual or entity (applicant or employee/contractor).
If the individual or entity is an
employee or contractor, the provider should also include the following
- Beginning and ending dates of the individual's or entity's employment or
contract with the agency,
- Documentation of termination of employment or contract, and
- Type of service(s) provided by the excluded individual or entity.
These findings should be reported to:
Department of Health and Hospitals
P.O. Box 91030
Baton Rouge, LA 70821-9030
This new adverse actions web search tool does not replace the Nurse Aide
Registry/Direct Service Worker Registry found at
Providers that employee Certified Nursing Assistants (CNA) and Direct Service
Workers (DSW) are still required to check these registries upon hire and every
six months thereafter.
These requirements are identified in the Provider Enrollment Agreements, the
Medical Assistance Program Integrity Law (MAPIL) cited as Louisiana Revised
Statute 46:437, referenced in the Louisiana Administrative Code (LAC) Title 50
and the Code of Federal Regulations 42 CFR § 455.436.
All excluded individuals must request reinstatement after the minimum excluded
period has been served. There is no automatic reinstatement at either the
federal or state level.
ATTENTION PROVIDERS REMINDER
On August 11, 2014, Molina systemically voided all
identified paid claims for legacy and shared plan recipients associated with the
retroactive enrollment or dis-enrollment of Bayou Health members and plan
linkages from February 1, 2012 through June 30, 2014. These voids appeared on
RAs with edit 999, Administrative Correction.
A Remittance Advice message ran from July 29, 2014 through August 12, 2014 and a
web notice was posted on August 8, 2014 notifying providers that DHH would void
all paid claims.
The 6 month deadline to resubmit these voided claims is
February 11, 2015.
We are reminding providers that this deadline is
All claims and required documentation must be resubmitted
to the correct entity by that date in order to be considered for payment.
Providers should refer to the web notice (08/06/14) or RA messages mentioned
above for detailed directions on how to resubmit these claims.
If you have any additional questions or concerns, please contact Darlene White
at (225)342-5924 or Darlene.White@la.gov
ATTENTION ALL PROVIDERS
CHANGES IN POST OFFICE BOXES FOR SUBMISSION OF PAPER CLAIMS
EFFECTIVE FEBRUARY 1, 2015
Effective February 1, 2015, Molina will be consolidating
several Post Office boxes and providers should begin sending claims to the newly
Below is a list of the Post Office boxes currently used
(indicated as Old Box Number) and a list of the corresponding 'New' box assigned
for that claim type (indicated as New Box Number).
this information with your staff and make the necessary changes in your internal
procedures to begin sending your paper claims to the new box immediately.
Old Box Number
New Box Number
(All Medicare Crossovers)
Program ended 2012; claims may no longer be submitted.
For questions related to this information, please contact
Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.
Thank you for your assistance in this matter.
REMINDER: ACA Primary Care Services Enhanced Rates End December 31, 2014
The Affordable Care Act requires State Medicaid programs to pay enhanced
rates for certain primary care services provided during calendar years 2013
For claims filed timely, the enhanced rates will continue to be paid for
dates of service during calendar years 2013 and 2014.
For services provided on or after January 1, 2015, the enhanced rates will
no longer apply and the regular Medicaid rates will be paid.
More information on the ACA Enhanced Reimbursement can be found online at
Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared
Plans and Legacy Medicaid:
Effective January 1, 2015, the dispensing fee portion of pharmacy
reimbursement methodology for Louisiana Medicaid Fee for Service (FFS)
Pharmacy Program will increase to $10.51.
Please refer to www.lamedicaid.com
ATTENTION GNOCHC PROVIDERS
For Demonstration Year 4 covering time period, 10/1/2013 - 9/30/2014, providers
must have submitted claims for processing no later than 11/14/2014. Claims
submitted after this date have been identified and will be voided in the
12/30/2014 check write.
ATTENTION ALL PROVIDERS
DHH has identified paid claims associated with administration corrections of
member's linkages into Bayou Health Plans. These linkage corrections were
necessary to ensure compliance with internal policies, approved Medicaid
State Plan and maintaining audit controls. Member linkages from July 1, 2014
through October 31, 2014 were evaluated and claims paid by an incorrect
entity (CHS, UHC or Molina) have been identified. On December 30, 2014,
Molina will systemically void all identified paid claims with a denial
reason code 999 Administrative Correction, which will be shown on the
In order to rebill, providers must verify the correct entity based on the
date of service by using either MEVS or REVS. To obtain consideration for
payment, providers are required to submit hard copy claims to the correct
entity no later than 6 months from the date the claim is voided. Legacy
Medicaid Claims must be sent through Molina's Provider Relations Department.
If PA or Pre-Cert was obtained on the original claim, providers will not be
required to obtain additional authorization when submitting these specific
prior-paid claims to the correct entity. Documentation must accompany
claims verifying the prior payment and void. This documentation of prior
payment will also support the authorization of the service. Claims
submitted within 6 months of the void date will not be denied based on
For this clean-up only, the Making Medicaid Better website
contains a list of affected providers which includes the provider name, a
partial Medicaid Provider ID (to protect privacy), the number of claims,
number of recipients, and total of payments to be voided. Questions may be
sent to Bayou Health at
with the subject lined addressed to "Retro Claims".
Beginning January 2015, the process of voiding identified paid claims will
be repeated on a monthly basis to occur around mid-month, for administrative
corrections made to member linkages in the prior month.
If you have any additional questions or concerns, please contact Darlene
White at (225) 342-9076 or
Billing Add-on Codes for Maternity-Related Anesthesia
Effective with date of processing November 25, 2014, typical add-on code processing rules were updated for obstetric anesthesia procedures codes 01967 and add-on codes 01968 and 01969. Add-on codes are not considered a full service, and in most cases, cannot be reimbursed without the primary procedure being billed and paid to the same attending provider. The exception to this is when more than one provider performs services over the duration of labor and delivery.
When an add-on code is used to fully define a maternity-related anesthesia service, the date of delivery should be the date of service for both the primary and the add-on procedure. This would apply regardless of whether the same or different providers bill for each service.
For questions related to this information as it pertains to legacy Medicaid or Bayou Health Shared Savings Plans claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.
Attention DME Providers
National Correct Coding Initiative (NCCI) Procedure to Procedure Edits
To Be Implemented for DME Providers
The Affordable Care Act requires that States incorporate NCCI edits and
methodologies for Medicaid claims processing. These edits are being
implemented for DME services in the coming months. DME NCCI code pairs can
be found on the CMS Medicaid website,
Procedure to procedure edits are defined as pairs of HCPCS/CPT codes that should not be reported together. These NCCI edits are applied to services performed by the same provider for the same recipient on the same date of service. When appropriate, modifiers may be applied to further describe the clinical scenario. Louisiana Medicaid's claims processing system is updated to accept all NCCI-associated modifiers.
Providers may NOT bill recipients for services denied by NCCI edits.
Providers could expect to see denials on procedures that may have previously
paid when billed in the same manner. For NCCI edits, the decision on which
procedure code of a code pair is payable is determined by CMS. CMS updates
these edits quarterly. DME providers may see new edit messages that pertain
specifically to the NCCI edits. Currently these are:
- 731-'CCI: Procedure incidental to another current procedure.'
- 759-'CCI: Procedure incidental to a procedure in history.'
- 982-'CCI: History procedure incidental to current-history voided.'
Each Bayou Health prepaid plan is required to implement NCCI editing, but may have slightly different
implementation schedules and billing policy related to the mandate. Please contact each prepaid health
plan for information specific to that plan.
Please continue to refer to notices on
for additional information as this transition
occurs. Providers are also encouraged to access information related to NCCI editing on the CMS website,
under the Medicaid link by entering 'NCCI' in the search box.
For questions related to this information as it pertains to legacy Medicaid or Bayou Health Shared Savings plans'
claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.