Claims and Billing

Below is 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.

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As a requirement of the Balanced Budget Act, the LA Encounter Data Certification 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.

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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.

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Medicaid Provider Billing

LDH has provided the links below to assist each Managed Care Organization in obtaining information regarding Medicaid Fee Schedules and Hospital Provider Per Diem Rates. 

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Medicaid Enterprise Systems

The Medicaid Enterprise Systems (MES) Division administers the contract and monitors the budget of the Medicaid Fiscal Intermediary (Gainwell Technologies), which is responsible for the payment of claims to providers and the timely and accurate reporting to state and federal personnel and private sector partners.
MES processes 51 million Medical claims annually for more than 30,000 Medicaid providers. 
To best accommodate business partners, the MES Division consists of two key operation units:

1. MARS Data Warehouse Reporting and Data Management
2. Recipient Reimbursement/Claims Resolution

The responsibilities in these sections are required by the Centers for Medicare and Medicaid Services (CMS) for a certified Medicaid Management Information System (MMIS).

EIDR Medicaid Claims Requests

EIDR Claims Reports for Long Term Care Facilities such as Nursing Homes and Adult Day Health Care Centers, and Hospitals are to be ordered through the Rate and Audit Review section. EIDR reports are available to the public in order to assist providers with their Cost Reports. This report costs 1/10^th of a cent per claim line with a minimum fee of $65.00 and will be delivered electronically via an Excel spreadsheet. Additional charges will apply if requesting overnight shipping of an electronic copy.

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For Long Term Care Facilities, email EIDR form to [email protected].

 

For Hospitals, email EIDR form to [email protected] and [email protected]. 

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