HIPAA training

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 →

Coding of Claims

Coding of Claims/Billing Codes Louisiana Healthcare Connections requires claims to be submitted using codes from the current version of ICD‐9‐CM, ICD‐10, ASA, DRG, CPT4, and HCPCS Level II for the date of service was rendered. These requirements may be amended to comply with federal and state regulations as necessary. Below are some code-related reasons a Read More →

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Successful Submission of EDI Claims (Louisiana Healthcare Connections Guides) Steps for successful submission of HIPAA Claims: Select clearinghouse to utilize. Contact clearinghouse to inform them you wish to submit electronic claims to Louisiana Healthcare Connections. Inquire with the clearinghouse what data records are required. Verify with Louisiana Healthcare Connections Customer Service Department that the provider Read More →

Invalid Electronic Claim

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 Read More →