For Medicaid Providers
Louisiana's Medicaid providers deliver valuable services to the state's Medicaid recipients, and their continued input and participation are critical to the state's health care delivery system.
Medicaid Management Information System (MMIS)
Most Medicaid provider relations functions are handled through the Medicaid Management Information System, which is responsible for processing providers' claims, issuing payment, enrolling/credentialing providers in the Medicaid network and assisting DHH's Bureau of Health Care Integrity in monitoring for fraud, waste and abuse.
Other Offices Important for Medicaid Providers:
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Overview of the State's managed care program, which coordinates Medicaid services for most Medicaid and LaCHIP recipients. |
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Licenses health care facilities to operate in the state of Louisiana and certifies these facilities for participation in Medicare and Medicaid; enforces regulatory compliance for health care facilities in the State of Louisiana.
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Develops and maintains a prior authorization process with a preferred drug list, makes recommendations for additions and deletions to the preferred drug list and advises the DHH secretary on policy recommendations related to the prudent administration of the Medicaid drug program. |
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Contributes specialized knowledge and experience and provides a two-way channel of communication with the individuals, organizations and institutions in the community that receive, provide and pay for medical care and services. |
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This section develops and administers complex reimbursement systems for several statewide Medicaid programs. It contracts with CPA consultant firms for the development of rate methodologies and for the audit of Medicaid providers participating in the programs stated above. It monitors these contracts, reviews and approves the consultants' audits, desk reviews and audit programs, and authorizes payments. |
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Through this program, eligible medical professionals and hospitals receive incentive payments for adopting, implementing or upgrading certified EHR technology during their first year of participation, and can earn payments for up to five subsequent years for demonstrating meaningful use of electronic health records. |
