In its most recent audit, the Louisiana Legislative Auditor reviewed the Louisiana Department of Health and identified a data systems issue that resulted in information not transmitted to the Department from its Medicaid managed care organizations.

The audit finding does not suggest, nor is there evidence, that claims were paid incorrectly.

The report by the Legislative Auditor determined that a number of claims paid to mental health providers did not include a National Provider Identification Number, or NPI, for the individual who provide the service as required by state law beginning January 1, 2019.

This finding came after the auditors reviewed data for these claims in the Department’s data system. However, these payments are not made directly by the Department, but instead by its Medicaid managed care contractors.

For the vast majority of claims reviewed, the NPI was included in the managed care contractors’ data systems. The audit finding stems from the NPI data not transferring from the contractors’ systems to Department’s system, which resulted in it not being found by the auditor.

Prior to the effective date of the law requiring the NPI number for individual providers, Jan. 1, 2019, the Department undertook numerous steps to comply with the requirement:

  • Added the NPI requirement to the contract between the MCOs and LDH;
  • Required MCOs to develop work plans to implement the new requirements;
  • Required MCOs to publish and transmit notifications of the requirements to providers throughout 2018;
  • Published Informational Bulletin 18-14 in the fall 2018 regarding the requirements
  • Conducted outreach and technical assistance to providers requesting information associated with requirements;
  • Provided technical assistance to MCOs requesting information about the requirements; and
  • Met individually with providers throughout the state, discussing the new requirements.

Since Jan. 1, the Department has continued to address technical and data systems issues identified with the requirement.