La medicaid fee schedule 2021

La medicaid fee schedule 2021 DEFAULT

Medicaid Provider Manuals and Other Resources

 

The intent of the service provider manual is to present useful information and guidance to providers participating in the Louisiana Medicaid Program. The first chapter, "General Information and Administration," contains information applicable to all enrolled providers. Each remaining chapter is dedicated to a specific program or service and outlines the policies, procedures, qualifications, services and limitations to that service or program.

Medicaid Administrative Claiming Program

Description: Pursuant to the Louisiana Legislature’s passage of R.S. 46:2721 in the 2001 Legislative Session creating the Medicaid School-Based Administrative Claiming Trust Fund, the Department of Health (LDH), Bureau of Health Service Financing (BHSF) initiated the creation of the Medicaid Administrative Claiming Program (MAC). Schools have a unique advantage and opportunity to outreach potential and current Medicaid recipients to help them access Medicaid covered services. The MAC Program is a Medicaid program in which school districts can be reimbursed for medically related administrative functions which the school district staff performs on behalf of Medicaid eligible and potentially eligible students. The reimbursement is contingent upon availability of state and federal matching funds. Administrative functions include such activities as outreach and assisting children in accessing Medicaid covered services. The school district agrees to follow a prescribed methodology of invoice claiming which must meet specific requirements including entering into interagency agreements with LDH and participating in approved uniform Centers for Medicare and Medicaid Services (CMS) time-studies.

Adult Day Health Care Waiver

Description: This provider manual chapter specifies the requirements for reimbursement for services provided through an approved waiver of the Title XIX regulations.

Ambulatory Surgical Center

Description: Sets forth the conditions and requirements an ASC must meet in order to qualify for reimbursement under the Louisiana Medicaid program. The manual is  a ready reference for information and procedural material needed for the prompt and accurate filing of claims for services furnished to Medicaid recipients.

American Indian 638 Clinics

Description: The Centers for Medicare and Medicaid Services (CMS) entered into a Memorandum of Agreement (MOA) with the Indian Health Services (IHS) to allow states to claim 100 percent federal medical assistance for payments made by the state for services rendered to Medicaid eligible American Indians and Alaska Natives through an IHS owned or leased facility or a tribal "638" facility. This manual outlines the covered services, recipient and provider requirements for IHS.

Applied Behavior Analysis

Description: Claims/authorizations for dates of service on or after October 1, 2015 must use the applicable ICD-10 diagnosis code that reflects the policy intent. References in this manual to ICD-9 diagnosis codes only apply to claims/authorizations with dates of service prior to October 1, 2015.

Behavioral Health Services

Description: Specialized behavioral health services (SBHS) are mental health services and substance use/addiction disorder services, specifically defined in the Medicaid State Plan and/or applicable waivers.

Case Management Services

Description: A provider's comprehensive resource for knowledge on a wide variety of Medicaid's operating practices and policies.

  • Issued: 07-01-2002
  • Revision Log :     No pages available.
  • Obsolete Pages: No pages available.

Children's Choice Waiver

Description: This chapter specifies the requirements for reimbursement for services provided through an approved waiver of the Title XIX regulations. This document is a combination of federal and state laws and LDH policy that provide support to such individuals.

Community Choices Waiver

Description: This chapter is intended to give providers of Community Choices Waiver services information necessary to fulfill their vendor contract with the State of Louisiana, and is the basis for federal and state reviews of the program. Full implementation of these regulations is necessary for a provider to remain in compliance with federal and state laws and Department rules.

Dental

Description: This chapter provides information on the Medicaid guidelines, policies, procedures, and claims filing requirements applicable to dental services provided to Medicaid recipients.

Durable Medical Equipment

Description: Defines the services, limitations, provider and recipient requirements, and prior authorization rules regarding Durable Medical Equipment

End Stage Renal Disease (ESRD)

Description: The purpose of this chapter is to set forth the conditions and requirements of ESRD facilities for reimbursement under the Louisiana Medicaid program.

EPSDT Health & Idea - Related Services

Description: This chapter provides information on the covered services, eligibility criteria, provider and program requirements of the EPSDT Medicaid program and IDEA-related services  for Medicaid recipients under 21 years of age.

Family Planning Clinics

Description: Defines the covered services, recipient and provider requirements and claims related information for Family Planning clinics.

Family Planning - Take Charge Plus

Description: Defines the waiver designed to decrease the rate of unintended pregnancies for women in the targeted population through access to family planning, and to decrease Medicaid expenditures for unintended pregnancy and related services through provision of family planning services.

Federally Qualified Health Centers (FQHC)

Description: The purpose of this chapter is to set forth the conditions and requirements that FQHCs must meet in order to qualify for reimbursement under the Louisiana Medicaid program. The manual chapter is intended to make available to Medicaid providers of FQHC services a ready reference for information and procedural material needed for the prompt and accurate filing of claims for services furnished to Medicaid recipients.

Free Standing Birthing Centers

Description: Free-standing birthing centers (FSBCs) provide delivery services to eligible Medicaid recipients not requiring hospitalization and which the expected duration of services would not exceed 24 hours following an admission.

General Information & Administration

Description: The purpose of this chapter is to present useful information and guidance to providers participating in the Louisiana Medicaid program. Policies and information applicable to provider requirements, recipient eligibility, program integrity and claims filing are provided in this reference guide.

Home Health

Description: Provides information on coverage, procedures, and claims filing requirements applicable to home health agencies.

Hospice

Description: Provides information on coverage, procedures, and claims filing requirements related to hospice services.

Hospital Services

Description: This manual chapter provides information relative to coverage policies for inpatient and outpatient hospital services. Information on provider requirements and claims related information are also included.

Independent Laboratories

Description: Outlines the conditions and requirements that independent laboratories must meet in order to qualify for reimbursement under the Louisiana Medicaid program. This chapter is a ready reference for information and procedural material needed for the prompt and accurate filing of claims for services furnished to Medicaid recipients.

Intermediate Care Facilities For Individuals With Developmental Disabilities

Description: This chapter specifies the requirements in maintaining an ICF/DD. This document is a combination of federal laws, state laws and Department of Health (LDH) policy.

LaHIPP TPL Claims Payments

Description: Federal regulations and applicable state laws require that third-party resources be used before Medicaid is billed.

Medical Transportation

Description: This chapter specifies the requirements of providing Non-Emergency Medical Transportation (NEMT), a non-ambulance transportation provided to Medicaid recipients to and from Medicaid covered services.

New Opportunities Waiver

Description: Provides a NOW provider the information needed to fulfill its vendor agreement with the State of Louisiana, and is the basis for federal and state reviews of the program.

PACE

Description: Provides information to aid the provider in understanding and implementing federal and state Program of All-inclusive Care for the Elderly (PACE) policies and procedures.

Pediatric Day Health Care

Description:  Outlines Pediatric Day Health Care (PDHC) Program which provides services to meet the medical, social and developmental needs of medically fragile children with complex medical conditions from birth up to 21 years of age.

Personal Care Services (LT-PCS AND EPSDT-PCS)

Description: This chapter outlines the PDHC program which provides services for Medicaid recipients who require assistance with the activities of daily living and are either in a nursing home or at imminent risk of nursing facility placement.

Pharmacy

Description: This chapter explains coverage, policies, procedures, and claims filing requirements applicable to the Pharmacy Program.  

Portable X-Ray

Description: Outlines the conditions and requirements that portable X-ray providers must meet in order to qualify for reimbursement under the Louisiana Medicaid program.

Professional Services

Description: This chapter offers the provider a description of Medicaid beneftis in the professional services program and the policies relating to those benefits.

Residential Options Waiver

Description: This chapter offers the provider a description of the Residential Options Waiver (ROW), a 1915(c) waiver, which is a service system centered on the needs and preferences of the recipients and integration of recipients within their communities.

Rural Health Clinics

Description: This chapter sets forth the conditions and requirements that RHCs must meet in order to qualify for reimbursement under the Louisiana Medicaid program.

Supports Waiver

Description: Outlines the regulations and requirements that providers must follow for participation in home and community-based waiver providers. Supported Employment, Day Habilitation, Prevocational, Habilitation, Respite, Housing Stabilization Transition, Housing Stabilization, Personal Emergency Response System, and Support Coordination are each defined in this chapter.

Vision (Eye Wear)

Description: Outlines the specific benefits and limitations involving Medicaid coverage for vision services and hardware.

RELATED INFO

 

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Sours: https://ldh.la.gov/index.cfm/page/1890

News

2021-10: SBHS Fee Schedule Rates Effective March 2021

Date: 03/10/21

Louisiana Healthcare Connections would like to let providers know that the updated Specialized Behavioral Health Services (SBHS) Fee Schedule has been posted to the Louisiana Medicaid website in both Excel and PDF format. The revised SBHS fee schedule is effective as of March 1, 2021.
 
The following changes should be noted:

  • CPT code 99451, Interprofessional Telephone/Internet/Electronic Health Record Assessment and Management with written report, appended with an effective date of 03/15/2021.  
  • HCPCS code H0038, Peer Support Specialist, appended with an effective date of 03/01/2021.

Louisiana Healthcare Connections will begin to update its systems to reflect these fee schedule changes. Claims will be recycled within 15 days with no action required by providers. 



Sours: https://www.louisianahealthconnect.com/newsroom/2021-10--sbhs-fee-schedule-rates-effective-march-2021.html
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Claims and Billing

Medicaid Recipient Insurance Information Update
The standardized form for updating third party liability (TPL) information for Medicaid recipients. The form includes instructions on where to send the TPL Update request and includes complete contact information prepopulated on the form.

LA Encounter Data Certification FormAs a requirement of the Balanced Budget Act, the form must be completed and uploaded to the MMIS SharePoint website concurrently along with the encounter data files sent to the Fiscal Intermediary for processing.

Health Plan Prior Authorization Requirements
Information from each of the five Health Plans about how to request prior authorization for a member.

Sample of e-MEVS screen for Health Coverage
This shows how to verify a Medicaid recipient's Health Plan in e-MEVS. If the member is enrolled in Managed Care, this information is reflected in the right column and lists the Health Plan.

EDI Submission Information for Health Plans
Information on how to sign up for electronic claims submission with each of the five Health Plans.

Medicaid Provider Billing
LDH has provided the links below to assist each Managed Care Organization in obtaining information regarding Medicaid Fee Schedules, Hospital Provider Per Diem Rates, Excluded Services Chart and most recently ICD-10 Implementation for Louisiana Medicaid Legacy Claims. 

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Sours: https://ldh.la.gov/index.cfm/page/1457
2021 Medicare Physician Fee Schedule

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