Fraud, Waste and Abuse (Louisiana Healthcare Connections) Some of the most common coding and billing issues are: Billing for services not rendered Billing for services at a frequency that indicates the provider is an outlier as compared with their peers. Billing for non-covered services using an incorrect CPT, HCPCS and/or Diagnosis code in order to … Read More →
Louisiana Healthcare Connections Claims Appeal In order to file an appeal the provider must have received an unsatisfactory response to a request for reconsideration. Submit the following items when filing an appeal: Claim Appeal Form (www.LouisianaHealthConnect.com) Original Request for Reconsideration letter and response Any supporting documentation supporting the request for an appeal The medical records … Read More →
Claims Disputes Requests for Reconsideration of a Claim All claim requests for claim reconsideration must be received within 180 calendar days from the date of notification of payment or denial was issued. A Request for Reconsideration is a communication (i.e., a typed letter) from the provider about a disagreement in the way a claim was … Read More →
Difference between Encounters VS Claims (Louisiana Healthcare Connections Explained) An encounter is a claim which is paid at zero dollars as a result of the provider being pre-paid or capitated for the services he/she provided Louisiana Healthcare Connections members. For example, if you are the PCP for a Louisiana Healthcare Connections member and receive a … Read More →