Changes are effective first quarter 2019 and updates have been included in the LDH Behavioral Health Services Provider Manual. Personal Wellness Assessment (PDF) Notification of Pregnancy (PDF) ... Louisiana Uniform Medicaid Prescription Drug Prior Authorization Form (PDF) Description: Federal regulations and applicable state laws require that third-party resources be used before Medicaid is billed. Know what to expect when your practice is audited; review the updated Audit Tool Elements on LDH’s website under the section for “ Behavioral Health Audit Tool Elements.” Find more provider information and resources with Aetna Better Health of Louisiana. Questions regarding managed care claims should be directed to the appropriate managed care organization. Description: This chapter provides information on the Medicaid guidelines, policies, procedures, and claims filing requirements applicable to dental services provided to Medicaid recipients. References in this manual to ICD-9 diagnosis codes only apply to claims/authorizations with dates of service prior to October 1, 2015. Description: Provides information to aid the provider in understanding and implementing federal and state Program of All-inclusive Care for the Elderly (PACE) policies and procedures. Medicaid Provider Manuals and Other Resources. Date: 11/15/19 On behalf of Louisiana Department of Health, Louisiana Healthcare Connections would like to inform providers about upcoming reimbursement changes. Description: Specialized behavioral health services (SBHS) are mental health services and substance use/addiction disorder services, specifically defined in the Medicaid State Plan and/or applicable waivers. Manual. Healthy Louisiana is Louisiana’s Medicaid program that provides quality, no-cost health insurance for low-income pregnant women, children and adults who qualify. Learn more about how we’re supporting members and providers. To request a free, printed copy of this manual, call Provider Services at 1-844-521-6942. Intermediate Care Facilities For Individuals With Developmental Disabilities. Provider Manual (PDF) Provider Manual – Vision Benefits (PDF) HEDIS 2020 Quick Reference Guide (PDF) Member Screenings and Program Referrals. Description: This chapter offers the provider a description of the Residential Options Waiver (ROW), a 1915(c) waiver, which is a service system centered on the needs and preferences of the recipients and integration of recipients within their communities. This document is a combination of federal laws, state laws and Department of Health (LDH) policy. Mailing Address: Louisiana Department of Health | P. O. Description: Claims/authorizations for dates of service on or after October 1, 2015 must use the applicable ICD-10 diagnosis code that reflects the policy intent. Your health plan and dental plan When you apply for Healthy Louisiana, you will choose a health plan and a dental plan, and may choose a Primary Care Provider (PCP) and Primary Dental Provider (PDP), for each family member who has Medicaid or LaCHIP. Provider Notice 2019-43: LPC and LMFT Reimbursement in FQHCs and RHCs. Description: Defines the waiver designed to decrease the rate of unintended pregnancies for women in the targeted population through access to family planning, and to decrease Medicaid expenditures for unintended pregnancy and related services through provision of family planning services. Personal Care Services (LT-PCS AND EPSDT-PCS). The manual chapter is intended to make available to Medicaid providers of FQHC services a ready reference for information and procedural material needed for the prompt and accurate filing of claims for services furnished to Medicaid recipients. Policies and information applicable to provider requirements, recipient eligibility, program integrity and claims filing are provided in this reference guide. Description: This provider manual chapter specifies the requirements for reimbursement for services provided through an approved waiver of the Title XIX regulations. Medicaid Behavioral Health Provider Resources. Box 629 | Baton Rouge, LA 70821-0629 Physical Address: 628 N. 4th Street | Baton Rouge, LA 70802 | PHONE: 225-342-9500 | FAX: 225-342-5568 Medicaid Customer Service 1-888-342-6207 | Healthy Louisiana 1-855-229-6848 If you are using a dial-up modem, we recommend you use the CD version of the Manual. On Dec. 1, 2015, Louisiana Medicaid changed the way members get behavioral health services (mental health and substance use treatment). The manual is divided into two major components, a general information and administration chapter and individual program chapters. We cover more than 465,000 members for medical care, pharmacy benefits and behavioral health services. Rather, this Louisiana Medicaid manual supplements the primary National Network Manual by focusing on the core service array, roles and responsibilities, as well as processes and procedures specific to the State of Louisiana Medicaid programs. State of Louisiana . BLAPEC-1472-19 [September 2019] Substance use disorder criteria and prior authorization Description: This chapter specifies the requirements in maintaining an ICF/DD. Description: This manual chapter provides information relative to coverage policies for inpatient and outpatient hospital services. Provider Manual Skip To: ... Use the Minnesota Medicaid Fee-For-Service drug search to review coverage parameters for individual national drug codes (NDCs). Description: The purpose of this chapter is to set forth the conditions and requirements of ESRD facilities for reimbursement under the Louisiana Medicaid program. Learn More. Providers are expected to periodically review the manual to ensure acccurate claims processing and reimbursement. Today, Aetna Medicaid serves nearly 3 million members through Medicaid managed care plans in 15 states: Arizona, California, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New York, New Jersey, Ohio, Pennsylvania, Texas, Virginia, and West Virginia. Full implementation of these regulations is necessary for a provider to remain in compliance with federal and state laws and Department rules. This document is a combination of federal and state laws and LDH policy that provide support to such individuals. Description: The purpose of this chapter is to present useful information and guidance to providers participating in the Louisiana Medicaid program. Learn more information on providers who participate in Louisiana Medicaid. We're All Together Now. Description: Defines the covered services, recipient and provider requirements and claims related information for Family Planning clinics. ... LOUISIANA MEDICAID PROGRAM ISSUED: 04/15/12 REPLACED: CHAPTER 24: … Description: Pursuant to the Louisiana Legislature’s passage of R.S. Provider Manuals The intent of the service provider manual is to present useful information and guidance to providers participating in the Louisiana Medicaid Program. Description: This chapter sets forth the conditions and requirements that RHCs must meet in order to qualify for reimbursement under the Louisiana Medicaid program. Description: Sets forth the conditions and requirements an ASC must meet in order to qualify for reimbursement under the Louisiana Medicaid program. They are also eligible to receive additional health care services and coverage through Louisiana Medicaid. The Louisiana Department of Health protects and promotes health and ensures access to medical, preventive and rehabilitative services for all citizens of the State of Louisiana. Provider Manuals Provider Updates Remittance Advice REVS TPL Recovery Request Website Enrollment Training/Policy Updates ... providers may access the Louisiana Medicaid Preferred Drug List ... July 1, 2019 through June 30, 2020. Description: This chapter outlines the PDHC program which provides services for Medicaid recipients who require assistance with the activities of daily living and are either in a nursing home or at imminent risk of nursing facility placement. Chapter twenty-four of the Medicaid Services Manual . The school district agrees to follow a prescribed methodology of invoice claiming which must meet specific requirements including entering into interagency agreements with LDH and participating in approved uniform Centers for Medicare and Medicaid Services (CMS) time-studies. Information on provider requirements and claims related information are also included. Description: Outlines the conditions and requirements that independent laboratories must meet in order to qualify for reimbursement under the Louisiana Medicaid program. 46:2721 in the 2001 Legislative Session creating the Medicaid School-Based Administrative Claiming Trust Fund, the Department of Health (LDH), Bureau of Health Service Financing (BHSF) initiated the creation of the Medicaid Administrative Claiming Program (MAC). In addition, some sections of the primary National Network Manual are repeated for convenience. To request a free, printed copy of this manual, call Provider Services at 1-844-521-6942. Box 629 | Baton Rouge, LA 70821-0629 Physical Address: 628 N. 4th Street | Baton Rouge, LA 70802 | PHONE: 225-342-9500 | FAX: 225-342-5568 Medicaid Customer Service 1-888-342-6207 | Healthy Louisiana 1-855-229-6848 Description: Defines the services, limitations, provider and recipient requirements, and prior authorization rules regarding Durable Medical Equipment. Louisiana Women, Infants and Children (WIC) program continues to provide pumps to eligible participants through the LA WIC Breast Pump Program. Each remaining chapter is dedicated to a specific program or service and outlines the policies, procedures, qualifications, services and limitations to that service or program. The Indiana Health Coverage Programs (IHCP) Medical Policy Manual contains information about Indiana Medicaid policies. Download the Medicaid, LaCHIP and LaMOMS provider manual online. The Alabama Medicaid Provider Billing Manual is a practical guide to assist Medicaid-enrolled providers in receiving reimbursement. ... 2019 Manual Revisions 2018 Manual Revisions 2017 Manual Revisions 2016 Manual Revisions Providers will be required to resubmit with the correct POS and modifier in order for claims to process. The Louisiana Department of Health has published updates to the Hospital Fee Schedule that took effect on July 1, 2019. Description: Outlines the conditions and requirements that portable X-ray providers must meet in order to qualify for reimbursement under the Louisiana Medicaid program. In 2003, we transformed the CMS Program Manuals into a web user-friendly presentation and renamed it the CMS Online Manual System. This manual outlines the covered services, recipient and provider requirements for IHS. ... 2019 Manual Revisions 2018 Manual Revisions 2017 Manual Revisions 2016 Manual Revisions In addition, some sections of the primary National Network Manual are repeated for convenience. This chapter is a ready reference for information and procedural material needed for the prompt and accurate filing of claims for services furnished to Medicaid recipients. In 2003, we transformed the CMS Program Manuals into a web user-friendly presentation and renamed it the CMS Online Manual System. We serve ABD, dual eligible members, and other populations similar to those in the Learn More. The Medicaid DME Provider Manual is the best source for the most up to date information on coverage of DME. Policy changes that have occurred since the effective date noted are announced in IHCP provider Bulletins and Banner Pages. Manuals It offers day-to-day operating instructions, policies, and procedures based on statutes and regulations, guidelines, models, and directives. Manuals It offers day-to-day operating instructions, policies, and procedures based on statutes and regulations, guidelines, models, and directives. Box 629 | Baton Rouge, LA 70821-0629 Physical Address: 628 N. 4th Street | Baton Rouge, LA 70802 | PHONE: 225-342-9500 | FAX: 225-342-5568 Medicaid Customer Service 1-888-342-6207 | Healthy Louisiana 1-855-229-6848 Schools have a unique advantage and opportunity to outreach potential and current Medicaid recipients to help them access Medicaid covered services. Rather, this Louisiana Medicaid manual supplements the primary National Network Manual by focusing on the core service array, roles and responsibilities, as well as processes and procedures specific to the State of Louisiana Medicaid programs. All other documents on this website are accessible using a dial-up modem. Description: This chapter explains coverage, policies, procedures, and claims filing requirements applicable to the Pharmacy Program. MHCP Provider Manual - Latest revisions to the Provider Manual for 2021. Description: The purpose of this chapter is to set forth the conditions and requirements that FQHCs must meet in order to qualify for reimbursement under the Louisiana Medicaid program. About Aetna Better Health of Louisiana Aetna Medicaid has been a leader in Medicaid managed care since 1986 and currently serves just over 2 million individuals in 16 states. All Medicaid members now get their behavioral health services through a Health Plan. Description:  Outlines Pediatric Day Health Care (PDHC) Program which provides services to meet the medical, social and developmental needs of medically fragile children with complex medical conditions from birth up to 21 years of age. February 10, 2021. Get covered with Louisiana Healthcare Connections today. This provider manual, as part of your Provider Agreement and related addendums, may be updated at any time and is subject to change. The first chapter, "General Information and Administration," contains information applicable to all enrolled providers. Mailing Address: Louisiana Department of Health | P. O. The number for Member Services is always located on the back of your UHC ID member card . ... Manuals, Forms and Resources Notices / Bulletins ... Spring 2019 Provider Newsletter (PDF) Summer 2019 Provider Newsletter (PDF) Fall 2019 Provider Newsletter (PDF) 2018. Doc#: PCA-1-016543-05292020_ 2020 V42.12102019 2020 Care Provider Manual Physician, Health Care Professional, Facility and Ancillary Care Louisiana The South Carolina Department of Health and Human Services (SCDHHS) reorganized its Medicaid provider manuals to give them a fresh look, and a user-friendly approach to accessing information. WellCare and Louisiana Healthcare Connections are bringing our health plans together. Description: Outlines the regulations and requirements that providers must follow for participation in home and community-based waiver providers. The most updated version is available online at https://providers.healthybluela.com. This provider manual, as part of your Provider Agreement and related addendums, may be updated at any time and is subject to change. Administrative functions include such activities as outreach and assisting children in accessing Medicaid covered services. Prior to inclusion of behavioral health services in this Medicaid Service Provider Manual in 2017, the Service Definition Manual version 9 (SDM v9) was in effect. February 10, 2021. Issued April 15, 2012 . Federally Qualified Health Centers (FQHC). Upon implementation, claims will deny without the combination of POS 02 and modifier 95. View the most recent published manual at the link below. Description: Free-standing birthing centers (FSBCs) provide delivery services to eligible Medicaid recipients not requiring hospitalization and which the expected duration of services would not exceed 24 hours following an admission. Medicaid Provider Manual. Interested in enrolling in the Healthy Louisiana Medicaid dental program? Find out why DentaQuest is a good fit for you and your children’s dental needs. The manual is a ready reference for information and procedural material needed for the prompt and accurate filing of claims for services furnished to Medicaid recipients. The manual is  a ready reference for information and procedural material needed for the prompt and accurate filing of claims for services furnished to Medicaid recipients. Description: The Centers for Medicare and Medicaid Services (CMS) entered into a Memorandum of Agreement (MOA) with the Indian Health Services (IHS) to allow states to claim 100 percent federal medical assistance for payments made by the state for services rendered to Medicaid eligible American Indians and Alaska Natives through an IHS owned or leased facility or a tribal "638" facility. For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website and select the “Learn about Medicaid Services” link. under the Provider Manuals link, within the Professional Services manual. Find more provider information and resources with Aetna Better Health of Louisiana. Medicaid Provider Manual Due to the size of this document (approximately 16MB), you may experience a delay before it opens. Medicaid. Effective August 1, 2019, providers will be required to use Place of Service (POS) 02 with modifier 95 for the billing of telemedicine/telehealth services. Revised provider manual goes into effect Humana provider manual revisions make it more user friendly A revised version of the Humana Provider Manual is now available and became effective on July 1, 2019. Louisiana Healthcare Connections offers Louisiana Medicaid and affordable health plans. Description: This chapter specifies the requirements of providing Non-Emergency Medical Transportation (NEMT), a non-ambulance transportation provided to Medicaid recipients to and from Medicaid covered services. Providers should refer to Chapter 3 and 4 of the Louisiana Medicaid Program Provider Manual for additional information on Provider Enrollment and Requirements, including General Standards for Participation. The update includes changes related to: Small Rural Hospital Inpatient per diems have increased effective 7/1/2019. Description: This chapter specifies the requirements for reimbursement for services provided through an approved waiver of the Title XIX regulations. Description: Sets forth the conditions and requirements an ASC must meet in order to qualify for reimbursement under the Louisiana Medicaid program. Description: Provides a NOW provider the information needed to fulfill its vendor agreement with the State of Louisiana, and is the basis for federal and state reviews of the program. Medical Policy Manual. PROVIDER MANUAL . Help Finding a Network Care Providers: If you need help finding a care provider in the UHC network or obtaining early prescription can call Member Services at 1-866-675-1607 (TTY: 711). Description: This chapter is intended to give providers of Community Choices Waiver services information necessary to fulfill their vendor contract with the State of Louisiana, and is the basis for federal and state reviews of the program. 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