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LA MCO Compounding Claims Submission
MMA is currently covering compound claims. All compounds must be submitted using the NCPDP version D.0 standard multi-ingredient compound functionality. Therefore, all ingredients must be identified, their units must be indicated, and the ingredient cost for each ingredient must be submitted on the claim.
At least one item in the compound must be a covered drug. Any component of a compound requiring PA will necessitate an approval prior to receiving payment. For additional information, refer to the Payer Specification document on the Plan Portal.
Refer to the LA MCO Compounding Claims Submission document here for more info.
Pharmacy Notice - Plan Reminder - Claim Submission Information
On October 28, 2023, Magellan Medicaid Administration (MMA) became the Single PBM for the approximately 1.7 million Beneficiaries of (6) six managed care organizations (MCOs): AmeriHealth Caritas, Aetna Better Health, Healthy Blue Louisiana, Humana Healthy Horizons, Louisiana Healthcare Connections, and United Healthcare Community Plan.
Click here to see claim submission information details
COB Processing Requirements
Magellan Medicaid Administration, LLC (MMA) is experiencing a high volume of claims and calls regarding Coordination of Benefits (COB) for covered beneficiaries for the Louisiana Medicaid Managed Care Program.
Refer to the LA Medicaid COB Processing requirements document here for more info.