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 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
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.
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.
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.