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 PROVIDERS: NON-THIRD PARTY LIABILITY RELATED CREDIT BALANCE AUDITS

Clarification of Credit Balance Audits

Effective January 1, 2014, Myers and Stauffer, LC will assume the responsibility for performing non-TPL-related Credit Balance Audits (CBA) to identify excess Medicaid payments.

Please contact Myers and Stauffer at LA_RAC@mslc.com to set up a secure FTP account for submitting reports.

Attention Hospital Providers:

Only one revenue code 450 or 459 may be used per emergency room visit. Providers continue to inappropriately bill multiple revenue codes 450 and 459. Programming logic is in place to deny claims billed with these multiple codes. One revenue code 450 or 459 (as appropriate) should be billed and should be accompanied by the correct, appropriate procedure code 99281-99285. Other procedure/HCPCS codes are inappropriate. Providers billing multiple codes 450 and 459 on lines displaying procedure codes other than 99281-99285 will receive denial edit 114 (invalid/ missing HCPCS). Denial edit 113 (only one ER revenue 450-459 code per visit) will appear when multiple claim lines are billed displaying the correct procedure codes 99281-99285. It is necessary for any provider billing multiple ER revenue codes and receiving these details to resubmit the single, correct revenue code line with the correct procedure/HCPCS code for consideration of payment.

Attention Pharmacists:

Prescriptions written for non-controlled medications for recipients enrolled in legacy Medicaid and Bayou Health Shared Plans will no longer expire after 6 months. Effective January 1, 2014, there will be a policy change and prescriptions for non-controlled substances shall expire after eleven authorized refills or one year after the date prescribed, whichever comes first. See www.lamedicaid.com for more information.

Attention Pharmacists:

Pharmacy claims for flu vaccine require the Professional Service Code Medication Administration (MA) in NCPDP field 440-E5. Claims billed without a MA value will deny. The following fields are also required: vaccine NDC, ingredient cost, incentive amount (administration fee), DUR/PPS Code Counter (value of 1), Prescriber ID, Provider ID, and Provider ID qualifier. See www.lamedicaid.com for more information and definitions of the Point of Sale (POS) fields.