Louisiana Department of Health & Hospitals | Kathy Kliebert, Secretary

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Statewide Initiatives

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Common Questions - Provider FAQ: Auths/Referrals/Covered Services

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What happens when a patient comes into our office and we find he is not linked to our Health Plan?
How difficult is it be to link a patient not in our Health Plan to our Health Plan?
How does DHH handle those patients that have Medicaid as a secondary insurance?
How do we verify eligibility?
Do the patient's still have different types of coverage (for example Family Planning, etc)?
Are Health Plans required to reimburse the current rates for provider based RHCs, or are they required to reimburse based on the cost + 10% formula for the duration of the contract?
In regard to non-emergency reimbursement, is the reimbursement 90% rate based on the CPT used?
What fee schedule is used?
What procedures require authorization?
How does managed care affect independent laboratories?
How does Bayou Health affect dentists?
What do the Bayou Health Plans do that Medicaid hasn’t done in the past?
How does authorization for non-emergency room, non PCP, outpatient primary care visits work?
Can a recipient choose a specialist as their PCP?
Do outpatient surgeries require prior authorization?
If a recipient goes to the ER, can they go to any hospital? If they need to be admitted, how would they be covered if their PCP/specialists doesn’t have admission rights at that hospital?
If a physician sends a patient to our facility to have a CT Scan for a diagnostic test, can we proceed with testing if we are not contracted with the patient's Health Plan?
If we provide emergent care to a patient that comes into the ER, and he is admitted, do we have to transfer him out of the facility when he’s stabilized, or do we seek prior authorization for continued care?
Are claims handled through Molina? Do patients still need to get referrals?
Are home health agencies contracting with Bayou Health?