Invalid Electronic Claim Record Rejections/Denials
All claim records sent to Louisiana Healthcare Connections must first pass the clearinghouse proprietary edits and plan‐specific edits prior to acceptance. Claim records that do not pass these edits are invalid and will be rejected without being recognized as received by Louisiana Healthcare Connections.
In these cases, the claim must be corrected and re‐submitted within the required filing deadline of 365 calendar days from the date of service. It is important that you review the acceptance or claim status reports received from the clearinghouse in order to identify and re‐submit these claims accurately.
Excluded Claim Categories
- Excluded from EDI Submission Options
- Must be Filed Paper
- Applies to Inpatient and Outpatient Claim Types
- Claim records requiring supportive documentation or attachments (Certification of Informed Consent‐Abortion, consent forms, medical records, etc.) (COB claims can be filed electronically, but if they are not all paper claims submitted with EOB payment information must mirror current EDI edits that require appropriate data in 9, 9a, 9d, and 11d on the CMS 1500)
- Claim for services requiring clinical review (e.g. complicated or unusual procedure)
- Provider is required to submit medical records with the claim.
- Claim for services needing documentation and requiring Certificate of Medical Necessity
- Oxygen, Motorized Wheelchairs.
To learn more about EDI and become a certified EDI Professional, please visit our course schedule page.