Louisiana Medical Group Management Association




Bayou Health Informational Bulletins for Providers CLICK HERE


Health Plan Advisories - These are available here


DHH encourages providers to contact MCOs directly for direction and issue resolution. Contacts are available in Informational Bulletin 12-27. Providers can submit any unresolved issues or suggestions to bayouhealth@la.gov. "

NOTICE - Behavioral Health Billing -- Health Informational Bulletin 15‐7

This revised DHH bulletin, effective March 1, 2015, replaces policies and procedures relative to behavioral health billing for Bayou Health members and makes obsolete all previous versions of Informational Bulletin (IB) 12‐18. SEE DETAILS HERE.  

Bayou Health Teleconference for Providers- Changes to Schedule:  Beginning Wednesday, April 1 and continuing through May 27, 2015, Bayou Health will host a provider call every other week. All calls will take place from noon to 1 p.m. Bayou Health may use interim weeks to host topic-specific calls, as needed. Any changes to the schedule or additional calls will be announced on the provider portal at www.makingmedicaidbetter.com and will be shared with the Bayou Health newsletter e-mail list. To sign up for this list, click here.

The need for future meetings will be determined after May 27.


TO PARTICIPATE:   Dial 1-888-278-0296. When prompted, enter access code 2833686 


DHH is posting notes from the calls here.

NOTICE: Informational Bulletin 15-6, "MCO CPT/HCPCS Update" (See links above for all bulletins)


In legacy Medicaid, until the claims system is updated, providers are asked to submit claims using new codes when appropriate. These claims will deny initially with a specific denial message, but the submission preserves timely filing of the claim. Once the new codes are on file, claims for that denial code are recycled with no action required by the provider.


The processes and timelines for the five Bayou Health Plans for adding new Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) procedure codes are as follows:


Aetna‐ Once we receive the new codes from Optum© our goal is to load them within 30 days. Providers should bill with new codes as appropriate and we will reprocess the claims; the provider does not need to resubmit. The goal is to load the fee schedules within 30 days of receipt. We will then reprocess any claims affected by the change.

Amerigroup‐ It is our policy to have the codes in the system before their effective date. The coding requirements are updated within our code editing software without regard to state coverage/existence on the Medicaid fee schedule. There are two aspects to any code update: the coding requirement update and the reimbursement/coverage update. The coding effective/termination dates are updated based on federal requirements. The reimbursement/coverage for each code is driven by the state’s fee schedule. Amerigroup updates the coding requirement prior to 2015. We update the coverage/reimbursement requirement after the state updates their fee schedule. Reimbursement amounts are not configured. If the new codes are not listed on the state’s fee schedule, then the codes are denied. The denial occurs due to the lack of existence on the state’s fee schedule. The state’s fee schedule drives the reimbursement amount.

AmeriHealth Caritas (ACLA) ‐ ACLA updates its claim system with new codes within 45 days of Molina posting the revised Louisiana Medicaid fee schedules. Until the Louisiana Medicaid fee schedules are updated, providers should call ACLA’s Utilization Department to request authorization for new codes. Providers are notified of the need to request authorization for miscellaneous and unlisted codes during provider orientation and in the provider handbook. If the provider files the claim before the new code is added to the system, the claim will deny but timely filing is preserved. When the new codes are loaded into ACLA’s system, authorized claims for the new codes are reprocessed with no additional action from the provider.

Louisiana Healthcare Connections ‐ Once DHH updates the fee schedules for the new 2015 codes, we require 45 – 60 days to review and implement configuration relating to covered/non‐covered status. The provider’s explanation of benefits (EOB) returns an explanation code of cL (DENY: NO ACTION NEEDED ‐ WILL BE REPROCESSED AFTER STATE REVIEWS NEW CODE) if the code is billed before a coverage determination is made. When that determination is made, all claims, whether covered or non‐covered, are reprocessed with no action required by the provider. Our fee schedules are updated within 30 days of an update posted by DHH.

United Healthcare (UHC)‐ Providers should bill with the most appropriate code available for the service provided. Providers whose reimbursement is based on the state’s fee schedules are paid a default rate for new codes until the state updates their fee schedules and those updates are applied in UHC’s system. Once the state rates are loaded, impacted claims will be recycled with no action required by the provider.


Attention:  All Providers:    Revisions have been made to the on-line Medicaid Recipient Insurance Information Update form found in www.lamedicaid.com. A drop-down box was added to the TO: field listing all 5 Bayou Health plan’s names, fax and phone numbers, as well as DHH’s fax and phone number. Providers should select and fax the form to the correct Bayou Health plan for each Medicaid recipient.  If the recipient is still in traditional Medicaid (no plan), the form should be faxed to DHH. This will assure that the appropriate persons are receiving the forms and completing the updates in a timely manner. The previous form is now obsolete so this form should no longer be submitted. Please use revised form only. See instructions below to locate form at www.lamedicaid.com.

Click on Forms/Files/User Manuals on the left navigational bar. Then, click on Online Forms. Scroll down to Medicaid Recipient Insurance Information Update Form - Private Insurance Plans and Medicare Advantage Plans.  Fill in form, print and fax to the plan or DHH.


If you have questions, please call Jackie Porta @ 225-342-9463 or Danny Murnane @ 225-342-4902.



KEEP UP WITH LOUISIANA MEDICAID: Their website is here. See the 2015 Check Write schedule by scrolling down. 


 Louisiana Department of Health and Hospitals, Bayou Health Informational Bulletin 15-3 February 12, 2015

Issue: Covered and Non-Covered Inpatient Hospital Days

Effective March 1, 2015, hospitals must bill Bayou Health Managed Care Organizations (MCOs) for covered days and their associated ancillary charges. Covered days are days that have been approved through the precertification process.

Hospitals may bill MCOs for non-covered days and their associated ancillary charges but these must be billed separately from covered days and their associated ancillary charges. Non-covered days are days that are not certified or approved by the MCO, and the associated ancillary charges are services or charges incurred on these non-covered days. Even though these non-covered days and services will be denied by the MCO, the MCO must submit a denied encounter for these claims if billed by the hospital.

When an MCO receives an inpatient claim (electronic or paper) that includes dates of service that exceed approved days, the MCO must deny the entire claim. The hospital must resubmit the inpatient claim for covered days only. For example:

• If a hospital obtains approval for a 10-day stay, and submits a claim for 12 days, the claim must be billed for the 10 approved days only.

837I Billing Instructions

• Service Line Items (SV203) – Line Item Charge Amount is the total charge amount for the Service-Line; it includes covered charges and non-covered charges (applicable for covered days only).

• For accommodation service line items, the number of covered accommodation service days value (quantity) shall be sent in SV205 along with SV204 set to “DA” (days).

• If the hospital identifies service line items with non-covered charges or line item charges that are denied by the MCO, the non-covered charges must be identified and reported in the SV207 on the encounter.

• The CLM02 (Total Claim Charge Amount) value shall equal the sum of all of the SV203 (Line Item Charge Amount) values.  Since the SV203 value includes both covered and non-covered  charges, CLM02 also includes both.

• HI*BE:80 – Covered Service Days (value in whole numbers only).

• HI*BE:81 – Non-Covered Service Days (value in whole numbers only).


Bayou Health Transparency Report January 2015     (Source: Louisiana Department of Health and Hospitals) See breakdowns/appendices within the report.


2015 Providers should check registries:   When selecting a Bayou Health Plan among Louisiana's five managed care organizations (MCOs), enrollees rely on the accuracy of the information contained in the Bayou Health provider registry and the MCO online directories. Providers need to check to be sure they are listed correctly. See details here.  


DHH announces plans to integrate behavioral health services into Medicaid managed care plans:  Currently provided through the Louisiana Behavioral Health Partnership (LBHP), specialized behavioral health services will be incorporated into Bayou Health by 2016. Louisiana’s Department of Health & Hospitals (DHH) has announced it will integrate specialized behavioral health services into the benefits coordinated by Bayou Health plans for more than 920,000 Medicaid recipients.  See more details here.


Bayou Health settlement reached - Federal judge to oversee compliance:  Louisiana’s DHH has settled a federal class-action lawsuit over the inadequacy of notices sent by DHH and Bayou Health insurance companies to Medicaid recipients. Details here.


RAC AUDITS: DHH Implements Recovery Audit Contractor Program  The new RAC program provides yet another mechanism by which DHH, through its contractors, can conduct post-payment audits of claims submitted by providers enrolled in Medicaid. For purposes of the rule, a provider is defined to be any healthcare entity enrolled with DHH as a provider in the Medicaid program. The provisions apply only to Medicaid RACs that begin on or after November 20, 2014, regardless of the dates of the claims reviewed. The provisions do not prohibit or restrict other audit functions that DHH or its contractors may perform.   Read details here at the Kean Miller website



Copyright, 2015 MGMA Louisiana

MGMA-Louisiana State Office / Phone: (985)290-8020/ 1527 Gause Blvd. #105/ Slidell, LA 70458

Advancing Leaders. Advancing PracticesTM