Louisiana Department of Health & Hospitals | Kathy Kliebert, Secretary

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Statewide Initiatives

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Common Questions - Provider FAQ: Billing and Reimbursement

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Can the physician expect his regular weekly payments from Molina?
How will the fee schedule be determined for new codes that come out each year?
Do you have to participate with the Health Plans to receive Medicaid secondary payment?
How does billing work?
What is the fixed rate floor equal to compared with fee for service?
What constitutes a clean claim? Can providers see examples?
The Prepaid plans - Amerigroup, AmeriHealth Caritas, and Louisiana Healthcare Connections - have electronic payers IDs. Should claims be submitted to the health plans for adjudication and payment?
Currently my institution does not bill Pre Evaluation services and includes these charges in the Medicaid Cost Report. I have been told that these charges should be billed to the Health Plans. In addition will there still be settlement on the Cost Report for Transplant?
Should we bill DHH or the Health Plans for hemophilia costs in excess of $50,000 on a patient by patient basis?
Where should claims be submitted for service to recipients in the Shared Savings Plans?
If an out-of-network hospital receives a reduced payment for the services to a member of a Health Plan (90% of payment for example), can the hospital bill the member for the 10% difference?
With the increase in per diems for NICU and PICU the volume of outliers will decrease, however is the Health Plan or DHH still responsible for Outlier Payments?
In my practice, if a person has a Medicaid application pending, we typically hold the billing for service for three months since it can take up to 90 days for Medicaid eligibility to be determined for new applicants. If eligibility is granted, should we bill Molina or the patient's Bayou Health plan?