Official Louisiana State Websites use .la.gov 
Secure .gov websites use HTTPS LDH is moving forward with a plan to distribute food benefits on EBT cards. If the USDA, who administers the SNAP program, is prepared and ready to move money into states’ accounts, we will use federal dollars to fund SNAP recipients’ accounts. If they are not ready, LDH will proceed with our state-funded program to provide food assistance to the elderly, the disabled, and households with children through their existing EBT cards.
Managed Care Organization Resources
Manuals and Companion Guides
- Managed Care Organization Manual (Updated 4.23.25)
- ABA Survey Manual (Updated 4.1.25) and Survey Data Reporting Template
- Chisholm MCO User Manual (Updated 4.2.25), Overview Video and Compliance Guide
- Crisis Response System Companion Guide
- DOJ Agreement Compliance Guide
- Justice-Involved Pre-Release Enrollment Program
- Medicaid 834 Benefit and Enrollment Transaction Set Companion Guide (Updated 1.15.24)
- Member Call Center Reporting Operational Guide
- Quality Companion Guide (Updated 5.2.2025)
- State Directed Payment Program Manual
- Prepaid Inpatient Health Plan CSoC Systems Companion Guide (Updated 10.15.24)
Report Templates
Weekly Reports (Due every following Wednesday by 5 p.m.)
Monthly Reports (Due 15th day of the month following end of reporting period, except where indicated otherwise)
| # | Report Name | Published Date |
|---|---|---|
| 010 | Grievance Appeal and SFH Report | 4/2/24 |
| 022 | Third Party Liability (TPL) Report | 12/16/22 |
| 039 | Case Management Report | 3/5/24 |
| 045 | Home Health Services Report | 12/16/22 |
| 047 | Crisis Response Team Home Health Services Report | 12/16/22 |
| 054 | Pharmacy Benefits Management Report | 12/16/22 |
| 055 | Pharmacy Report (RX055) | 12/16/22 |
| 107 | Member Service Call Center (Due 5th day of the month) | 7/8/25 |
| 137 | Pregnancy Report | 12/16/22 |
| 148 | Exclusion Database Attestation | 12/16/22 |
| 162 | Health Plan Drug Utilization Review Report | 3/11/24 |
| 165 | Lock-In Report | 2/18/25 |
| 173 | Denied Claims Report | 12/16/22 |
| 175 | Hepatitis C | 7/25/24 |
| 181 | Provider Call Center Report | 11/15/23 |
| 182 | Provider Complaint and Appeal Summary Report | 9/14/23 |
| 221 | Claims Payment Summary | 10/30/25 |
| 323 | Chisholm Monthly Behavioral Health ASD Report | 12/16/22 |
| 326 | Adverse Incident Report (Instuctions, Form) | 6/23/23 |
| 337 | Behavioral Health Out-of-State Treatment Report | 12/16/22 |
| 354 | Chisholm PCS Member Aging Out Report | 12/16/22 |
| 360 | NEMT Oversight Report | 12/16/22 |
| 361 | Community Case Management Report | 7/8/25 |
| 409 | Behavioral Health Grievance, Appeal, and State Fair Hearing Logs | 6/10/24 |
| 412 | State Directed Payments: Nurse Recruitment and Retention | 7/12/24 |
| 413 | Overpayments and TIPS Report | 11/18/24 |
| 415 | Chisholm Monthly PAL Tracker | 9/18/25 |
Bi-Monthly Reports (Due February 28, April 30, June 30, August 31, October 31 and December 31)
| # | Report Name | Published Date |
|---|---|---|
| 20 | Payment Discrepancy Report | 12/16/22 |
Quarterly Reports (Due April 30, July 30, October 30, and January 30, except where indicated otherwise)
| # | Report Name | Published Date |
|---|---|---|
| 011A | MCIP Achievement Report - Quality and Outcome Improvement Network | 6/4/25 |
| 011B | MCIP Achievement Report - Louisiana Quality Network | 4/22/25 |
| 069 | Utilization Management Medical Review Report | 2/13/23 |
| 109 | Marketing and Member Education Activities Report | 2/13/23 |
| 119 | QAPI Committee (Minutes) | 2/13/23 |
| 145 | Fraud Waste and Abuse Report | 8/9/23 |
| 147 | Sampling of Paid Claims Report | 5/2/23 |
| 152 | Act 710 Healthy Louisiana Claims Report | 11/15/23 |
| 160 | Medication Therapy Management Report | 12/18/24 |
| 185 | Quarterly Unaudited Financial Statement (Due 5/31, 8/31, 11/30 and 2/28) | 2/28/23 |
| 188/188BH | Service Authorizations | 11/30/23 |
| 312 | Gambling and Tobacco Report (Due 8th day of the month following reporting period) | 10/24/23 |
| 313 | Access to Wraparound Services Report | 2/27/23 |
| 317 | PASRR Report | 6/3/25 |
| 328 | Behavioral Health Provider Network Detail Report | 2/28/23 |
| 329 | Children in Restrictive Settings | 2/27/23 |
| 336 | Behavioral Health Providers by Level of Care Report | 2/27/23 |
| 338 | Behavioral Health Network Adequacy and GEO Access Review | 2/28/23 |
| 339 | Behavioral Health Prescriber Sufficiency Summary Report | 3/1/23 |
| 346 | Provider Credentialing and Contracting Report | 10/11/23 |
| 348 | Geo Access Mapping (Attestation Form) | 3/1/23 |
| 358 | Behavioral Health Quality Monitoring Report | 10/20/23 |
| 359 | Behavioral Health Network Appointment Availability Report | 2/27/23 |
| 408 | Specialized Behavioral Health Provider Network Monitoring | 3/1/23 |
| 410 | State Directed Payments: EBP Incentive/Retention | 11/18/24 |
| 411 | ABA QualityMonitoring Report | 2/8/24 |
| 414 | State Directed Payments: LMHP Incentives/Retention | 11/18/24 |
Semi-Annual Reports
Annual Reports
| # | Report Name | Published Date | Due Date |
|---|---|---|---|
| 011A | MCIP Achievement Report - Quality and Outcome Improvement Network | 6/4/25 | March 30 |
| 011B | MCIP Achievement Report - Louisiana Quality Network | 4/22/25 | March 30 |
| 012A | MCIP Annual Progress Reporting - Quality and Outcome Improvement Network | 6/6/25 | July 31 |
| 012B | MCIP Annual Progress Reporting Template - Louisiana Quality Network | 6/6/25 | July 31 |
| 017 | Key Staff Organizational Chart Listing | 3/5/24 | Jan. 30 |
| 019 | Medical Loss Ratio | 9/17/24 | Jan. 15 |
| 053 | Specialized Behavioral Health NW Provider Development Management Plan | 1/6/23 | Jan. 30 |
| 056 | PCMH Implementation Plan | 1/6/23 | Jan. 31 |
| 132 | Member Satisfaction Survey (CAHPS) | 6/13/23 | Aug. 30 |
| 136 | QAPI Program Description, Work Plan, Impact and Effectiveness of Program Evaluation | 1/31/23 | March 31 |
| 138 | QAPI Performance Improvement Projects | 9/26/23 | March 15 |
| 141 | Member Advisory Council | 9/26/23 | Jan. 30 |
| 170 | Disclosure of Ownership and Control Interest Statement | 1/27/23 | March 30 |
| 177 | Total and out of Network Claims Report | 5/15/23 | July 30 |
| 184 | Annual Audited Financial Statement | 4/2/25 | June 30 |
| 189 | Independent-Subcontractor EDP Audit (SSAE16) | 5/23/23 | Based on Audit Period |
| 300 | NCCI MCO Cost Savings | 1/28/25 | July 15 |
| 334 | Integration Assessment Report | 2/21/24 | March 28 |
| 349 | Unmet Service Needs Resolution Plan | 3/17/23 | April 30 |
| 410 | State Directed Payments: EBP Incentive/Retention | 11/18/24 | July 30 |
| 414 | State Directed Payments: LMHP Incentives/Retention | 11/18/24 | July 30 |
Marketing and Member Education Resources
Member Education Template Checklists
- Handbook (Updated 7/1/2022)
- Welcome Newsletter (Updated 7/1/2022)
Other Resources
- CMS approved directed payments arrangements
- Directed Payment Reports
- Executed Contracts
- Full Medicaid Payment (FMP) Reports (coming soon)
- Medical Care Advisory Committee
- Pharmacy Letter Templates
- Quality Management Strategy for the Louisiana Medicaid Managed Care Program (Updated March 2023)
- Rate Certification Letters