Billing Requirements For Providers (Louisiana Healthcare Connections)

Billing Requirements For Providers (Louisiana Healthcare Connections)Physicians, other licensed health professionals, facilities and ancillary provider’s contract directly with Louisiana Healthcare Connections for payment of covered services. It is important that providers ensure Louisiana Healthcare Connections has accurate billing information on electronic file.

Providers should confirm that the following information is current in Louisiana Healthcare Connections files:

  • Provider name (as noted on current W-9 form)
  • National Provider Identifier (NPI)
  • Tax Identification Number (TIN)
  • Taxonomy code
  • Physical location address (as noted on current W-9 form)
  • Mailing location for all correspondence (including manual payments, if applicable)
  • Billing name and address.

Louisiana Healthcare Connections recommends that providers notify Louisiana Healthcare Connections as soon as possible, but no later than 30 days in advance of changes pertaining to billing information. Please submit this information on a W-9 form. Changes to a provider’s TIN and/or address are not acceptable when conveyed via a claim form.

Claims eligible for payment must meet the following requirements:

  • The member is effective on the date of service;
  • The service provided is a covered benefit under the member’s contract on the date of service; and
  • Referral and prior authorization processes were followed, if applicable. Payment for service is contingent upon compliance with referral and prior authorization policies and procedures.

When required data elements are missing or are invalid, claims will be rejected or denied by Louisiana Healthcare Connections for correction and re‐submission.

For Electronic Data Interchange (EDI) claims, rejections happen through one of Louisiana Healthcare Connections EDI clearinghouses if the appropriate information is not contained on the claim.

Denials happen once the claim has been received into the claims adjudication system and will be sent to the provider via an EOP or Electronic Remittance Advice (ERA). Claims for billable services provided to Louisiana Healthcare Connections members must be submitted by the provider who performed the services or by the provider’s authorized billing vendor.

To learn more about EDI and become a certified EDI Professional, please visit our course schedule page.

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