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 Read More →

EDI Claims Submission

Louisiana Healthcare Connections EDI Claims Submission Louisiana Healthcare Connections values its providers and appreciates the administrative and financial complexities of managing a health care practice. It is committed to being the plan for success, and processing claims timely to help providers receive payment as quickly as possible. Louisiana Healthcare Connections is required by state and federal regulations to capture Read More →

Provider Data Accuracy

Louisiana Health Connect Guidelines Submitting provider data updates is a contractual requirement for all providers in Louisiana Health Connect network. In addition to audits by the LDH, Louisiana Healthcare Connections is increasing the frequency and volume of secret shopper audits to confirm provider directory data. This step is necessary to ensure our members have reliable Read More →

Denied Claims

Denied Claims (Oklahoma Medicaid Management Information System) Claims can be denied at either the header or detail levels. The header level contains information about the member and provider, but not about the services performed. This is where the OKMMIS will verify member’s eligibility and provider’s contract information. Denials at this level will cause the entire Read More →

Paid Claim Adjustment

Paid Claim Adjustment Procedures. Non-Check Related Adjustments (Oklahoma Medicaid Management Information System (OKMMIS) It is the responsibility of the adjustment department to process in a timely manner all claim-specific and non-claim-specific financial transactions. When a claim is adjusted, it is reprocessed as a new claim. When the adjustment claim processes, it may be affected by system Read More →

Suspended Claims

Suspended Claims, Resubmit Status, And Working Denied Claims (Oklahoma Health Care Authority Explained) Suspended claims are claims that are currently still in process. Claims suspend when they cannot be automatically adjudicated or require additional review. Suspended claims are forwarded to a resolutions department for manual review. For example, if a claim has a primary insurance payment, the claim Read More →

Denied Claims

Denied Claims (Oklahoma Health Care Authority Guides) Denied claims are claims that have been determined not covered by Oklahoma SoonerCare. These denials may be issued for various reasons including: non-covered services, inaccurate information submitted on the claim, member’s eligibility, or the provider’s contract information. Claims denied for non-covered service could be due to program restrictions Read More →


Oklahoma Health Care Authority HIPAA Transactions Requirements The Health Insurance Portability and Accountability Act (HIPAA) is a national effort driven by the Department of Health and Human Services (DHHS) and the Centers for Medicare and Medicaid Services (CMS) geared toward administrative simplification and electronic submission standardization. The HIPAA influences the way protected health information (PHI) is Read More →

HIPAA training

How to deal with Paper Attachments to Electronic HIPAA Claims? OCHCA Explained An attachment cover sheet, form HCA-13, is available for every attachment to be submitted with electronic claims or electronic PA requests. HCA-13 allows claims or PA request submitters to continue billing their claims or PA requests electronically, even if an attachment needs to be sent Read More →

835 Remittance Advice

The 835 Remittance Advice  Transaction Set Guidelines (OCHCA) The EDI 835 transaction will only be used to send an Explanation of Benefits (EOB) RA. For SoonerCare, payment is separate from the EOB RA and will therefore not be affected by changes to how the provider receives payment – via paper or electronically. The 835 transaction will be Read More →