Schools have a unique advantage and opportunity to outreach potential and current Medicaid recipients to help them access Medicaid covered services. Provider Manual (PDF) Provider Manual – Vision Benefits (PDF) HEDIS 2020 Quick Reference Guide (PDF) Member Screenings and Program Referrals. 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. 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. BLAPEC-1472-19 [September 2019] Substance use disorder criteria and prior authorization Description: This chapter provides information on the Medicaid guidelines, policies, procedures, and claims filing requirements applicable to dental services provided to Medicaid recipients. Louisiana Healthcare Connections offers Louisiana Medicaid and affordable health plans. 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. To request a free, printed copy of this manual, call Provider Services at 1-844-521-6942. References in this manual to ICD‐9 diagnosis codes only apply to Policies and information applicable to provider requirements, recipient eligibility, program integrity and claims filing are provided in this reference guide. The most updated version is available online at https://providers.healthybluela.com. LOUISIANA MEDICAID ELIGIBILITY MANUAL (MEM), A - 0000 Abbreviations / Acronyms / Definitions - Outline, H - 0000 Eligibility Determinations - Outline, J - 0000 Medicaid Eligibility Cards and Optional State Supplement Payments, H - 900 Home and Community Based Services (HCBS), H - 1000 Medically Needy Program - General Information, H - 1020 Regular and Spend-Down Medically Needy - MAGI Related, H - 1030 Spend-Down Medically Needy - SSI Related, H - 1040 Spend-Down Medically Needy - Long Term Care - SSI Related, H - 1050 Spend-Down Medically Needy - Home and Community Based Services - SSI Related, H - 1100 Qualified Medicare Beneficiary (QMB), H - 1200 Qualified Disabled and Working Individuals (QDWI), H - 1300 Specified Low-Income Medicare Beneficiary (SLMB), H - 1400 Breast and Cervical Cancer Program, H - 1800 Retroactive Medicaid Eligibility (RME), H - 1900 Twelve (12) Months Continuous Eligibility, H - 2000 Qualifying Individuals Program (QI), H - 2300 Family Opportunity Act Medicaid Program, H - 2700 Louisiana Behavioral Health Partnership, H - 3200 Hospital Presumptive Eligibility (HPE), H - 3600 Program of All Inclusive Care for the Elderly (PACE), I - 300 Citizenship / Identity and Qualified Non-Citizen Status, I - 400 Continuity of Stay (LTC Only, Except HCBS), I - 1000 Medical Certification (LTC and HCBS Only), I - 1200 Mother's Medicaid Eligibility (Deemed Eligible Children Only), I - 1600 Need - Resources - General Information, I - 1660 Spousal Impoverishment Resource Provisions (LTC/HCBS), I - 1670 Transfer of Assets For Less Than Fair Market Value, I - 2100 Supplemental Security Income (SSI) Eligibility, Z - 100 Maximum SSI Student Child Earned Income Exclusion Amounts, Z - 200 Federal Poverty Income Guidelines, Z - 300 Medically Needy Income Eligibility Standards (MNIES), Z - 500 Filing Requirements for Children and Tax Dependents, Z - 700 LTC/HCBS SIL Rate, Resource Limits and Personal Care Needs Allowance, Z - 800 Spousal Impoverishment Maintenance Needs and Resource Standards, Z - 1000 Maximum Resource Limits as of 12-73 for Grandfathered/Converted SSI Recipients, Z - 1100 Maximum Grants for MMS Categories A, B and D Prior to Conversion to SSI, Z - 1300 Usufruct and Remainder Interest Tables, Z - 1400 Social Security Cost of Living Adjustment (COLA) Extended Medicaid Only, Z - 1700 7/16/96 AFDC Need Standard and Flat Grants, Z - 2200 Medicare Savings Program Resource Limits, Z - 2400 Average Projected Rates For MNP By Program. Your health plan and dental plan When you apply for Healthy Louisiana, you will choose a health plan and a dental plan, and may choose a Primary Care Provider (PCP) and Primary Dental Provider (PDP), for each family member who has Medicaid or LaCHIP. Description: Sets forth the conditions and requirements an ASC must meet in order to qualify for reimbursement under the Louisiana Medicaid program. Louisiana Women, Infants and Children (WIC) program continues to provide pumps to eligible participants through the LA WIC Breast Pump Program. Medicaid Provider Manual Due to the size of this document (approximately 16MB), you may experience a delay before it opens. Description: Defines the services, limitations, provider and recipient requirements, and prior authorization rules regarding Durable Medical Equipment. 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. Box 629 | Baton Rouge, LA 70821-0629 Physical Address: 628 N. 4th Street | Baton Rouge, LA 70802 | PHONE: 225-342-9500 | FAX: 225-342-5568 Medicaid Customer Service 1-888-342-6207 | Healthy Louisiana 1-855-229-6848 Description: This chapter explains coverage, policies, procedures, and claims filing requirements applicable to the Pharmacy Program. Your health plan will provide any physical health services you qualify for and mental health and substance use … Mailing Address: Louisiana Department of Health | P. O. Description: A provider's comprehensive resource for knowledge on a wide variety of Medicaid's operating practices and policies. Find more provider information and resources with Aetna Better Health of Louisiana. Medicaid Provider Manual. Description: The purpose of this chapter is to present useful information and guidance to providers participating in the Louisiana Medicaid program. We're All Together Now. 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. 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. 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. Find more provider information and resources with Aetna Better Health of Louisiana. MCNA Dental has a large network of general and specialty dentists throughout Louisiana to make sure … Know what to expect when your practice is audited; review the updated Audit Tool Elements on LDH’s website under the section for “ Behavioral Health Audit Tool Elements.” Learn More. The Alabama Medicaid Provider Billing Manual is a practical guide to assist Medicaid-enrolled providers in receiving reimbursement. Box 629 | Baton Rouge, LA 70821-0629 Physical Address: 628 N. 4th Street | Baton Rouge, LA 70802 | PHONE: 225-342-9500 | FAX: 225-342-5568 Medicaid Customer Service 1-888-342-6207 | Healthy Louisiana 1-855-229-6848 The manual is divided into two major components, a general information and administration chapter and individual program chapters. The full fee schedule can be reviewed on the Louisiana Medicaid Provider website. It was last updated in 2013. The Louisiana Department of Health protects and promotes health and ensures access to medical, preventive and rehabilitative services for all citizens of the State of Louisiana. Learn more information on providers who participate in Louisiana Medicaid. Learn more about how we’re supporting members and providers. Changes are effective first quarter 2019 and updates have been included in the LDH Behavioral Health Services Provider Manual. Federally Qualified Health Centers (FQHC). Description: The purpose of this chapter is to set forth the conditions and requirements of ESRD facilities for reimbursement under the Louisiana Medicaid program. ... DentaQuest Provider Service Numbers: Aetna Better Health of Louisiana: 800-508-6785 Healthy Blue: 800-508-6785 View the most recent published manual at the link below. Intermediate Care Facilities For Individuals With Developmental Disabilities. Description: Sets forth the conditions and requirements an ASC must meet in order to qualify for reimbursement under the Louisiana Medicaid program. Description: This chapter sets forth the conditions and requirements that RHCs must meet in order to qualify for reimbursement under the Louisiana Medicaid program. Description: Outlines the conditions and requirements that portable X-ray providers must meet in order to qualify for reimbursement under the Louisiana Medicaid program. Mailing Address: Louisiana Department of Health | P. O. Interested in enrolling in the Healthy Louisiana Medicaid dental program? PROVIDER MANUAL Chapter Five of the Medicaid Services Manual Issued February 1, 2012 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. Personal Care Services (LT-PCS AND EPSDT-PCS). All Medicaid members now get their behavioral health services through a Health Plan. We serve ABD, dual eligible members, and other populations similar to those in the To request a free, printed copy of this manual, call Provider Services at 1-844-521-6942. This document is a combination of federal laws, state laws and Department of Health (LDH) policy. Medical Policy Manual. Providers will be required to resubmit with the correct POS and modifier in order for claims to process. 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