Print Page   |   Contact Us   |   Sign In   |   Join Now!
Healthy Louisiana (Medicaid) Resource Center

Healthy Louisiana is the portion of the Louisiana Medicaid program that is operated under managed care. All public information concerning the program can be accessed at the Louisiana Department of Health (LDH) website. The Healthy Louisiana program is operated by five health plans. The plans are the following:

 

Patient Information

Click here for Healthy Louisiana Website

Click here to locate a provider (physician)

Phone # 1.888.342.6207 or Email MedWeb@la.gov

Phone # 1.855.229.6848 or Email Healthy@La.Gov

 

Provider Call for Information

LDH continues to hold a provider phone call at noon every other Wednesday to address providers' Bayou Health questions. Any provider is welcome to call in, and pre-registration is not required. The call in number is 1-888-278-0296, and the access code is 2833686#.

 

 

Informational Bulletins

The Louisiana Department of Health has created a set of information bulletins that contain guidance on many of the most common Health Louisiana issues. These bulletins can be accessed by clicking here

 

Reports

The Louisiana Department of Health has made publicly available some limited reports on the Program. 

 

Complaints About Bayou Health

There are three ways to register complaints about the Bayou Health program.

1.     Complaints can be sent directly to LDH by clicking here.  

2.     Provider Complaint Escalation Chart for Health Plans - The Healthy Louisiana contracts with LDH require that each plan operate a toll-free telephone line to respond to provider questions, comments, and inquiries. This line is required to be staffed from 7 am to 7 pm CT Monday through Friday. In addition, the plans are required to maintain a Provider Complaint System for physicians to dispute health plan policies, procedures, or any aspect of the plan’s administrative functions. This chart has the requisite contact information. The LSMS strongly recommends that physicians document the name of the plan representative with whom they speak or communicate with via email and document the time and date that contact is made with a plan representative.

3.     Lastly, if you cannot get resolution, contact  Sabrina Noah, LSMS Policy and Program Manager. Please provide as much information as possible and a valid email and telephone number where you can be contacted. (Please try to avoid emailing any patient specific information that may be protected by HIPPA).

 

Pharmacy Services

The Louisiana Department of Health pharmacy services are included as a benefit in Healthy Louisiana. Pharmacy services remain in legacy Medicaid for recipients not enrolled in Bayou Health. Pharmacy provider relations support for legacy Medicaid will continue to be handled by the Medicaid fiscal intermediary, Molina.

 

Pharmacy Transition Resources for Providers

Medicaid leadership have established resources in place to assist pharmacists and prescribing providers during the Healthy Louisiana pharmacy integration. To ensure questions are answered quickly and accurately, pharmacists are encouraged to first direct pharmacy integration specific questions to the appropriate plan. Questions can be directed by plan as follows:

 

Aetna

General Provider Issues - Call Provider Relations - 1-855-242-0802

Pharmacy Contracting Issues - Call CVS Health - 1-855-364-2977

Aetna Member with Issues - Have the Member Call Member Services - 1-855-242-0802

Claims/Billing Issues - Call CVS Health - 1-855-364-2977

Pharmacy Billing Information

BIN: 610591

PCN:ADV

Group: RX8834

 

Amerigroup

General Provider Issues - Call Provider Relations - 1-800-454-3730

Pharmacy Contracting Issues - Call Express Scripts - 1-888-571-8182

Amerigroup Member with Issues - Have the Member Call Member Services - 1-800-600-4441

Claims/Billing Issues - Call Express Scripts - 1-844-367-6111

Pharmacy Billing Information

BIN: 003858

PCN: MA

Group: WKLA

 

AmeriHealth Caritas

General Provider Issues - Call PerformRx Provider Relations - 1-800-684-5502

Pharmacy Contracting Issues - Call PerformRx - 1-800-555-5690

AmeriHealth Caritas Member with Issues - Have the Member Call Perform Rx Member Services - 1-866-452-1040

Claims/Billing Issues - Call PerformRx - 1-800-684-5502

Pharmacy Billing Information

BIN: 600428

PCN: 06030000

 

Louisiana Healthcare Connections

General Provider Issues - Call Provider Relations - 1-866-595-8133

Pharmacy Contracting Issues - Call US Script - 1-877-690-9330

Louisiana Healthcare Connections Member with Issues - Have the Member Call Member Services - 1-866-595-8133

Claims/Billing Issues - Call US Script Provider Relations - 1-877-690-9330

Pharmacy Billing Information

BIN: 008019

 

United Healthcare

General Provider Issues - Call Provider Relations - 1-866-675-1607

Pharmacy Contracting Issues - Call OptumRx - 1-800-797-9798

United Healthcare Member with Issues - Have the Member Call Member Services - 1-866-675-1607

Claims/Billing Issues - Call OptumRx - 1-866-328-3108

Pharmacy Billing Information

BIN: 610494

PCN: 9999

Group: ACULA

Any other pharmacy-related questions can be directed to the Medicaid Pharmacy Program at 1-800-437-9101.

 

 

Resources & Links

  • Centers for Medicare and Medicaid Services (CMS) - This site has a wealth of information concerning the Medicaid Program.
  • La. Medicaid - Primary website and portal for physicians providing Medicaid services in the "fee-for-service" program. This site is maintained by Molina, which is the current Medicaid fiscal intermediary.
  • Medicaid Provider Manuals - The provider manuals for fee-for-service or legacy Medicaid can be accessed here.
  • Medicaid Fee Schedules - A compendium of the Medicaid fee-for-service fee schedules. For those providers in Bayou Health, these fee schedules represent the floor that may be reimbursed to contracted providers.
  • Medicaid Services Chart - This chart details the services provided under the Medicaid program.
  • Medicaid State Plan - This document is required by the federal government and is the sole governing document of the Louisiana Medicaid program.
  • Medicaid Eligibility Manual - This document sets forth all eligibility categories and requirements for the program.
  • Medicaid Annual Reports - This document is produced on an annual basis by DHH and generally covers financial information on a fiscal basis with a two-year lag.
  • Medicaid Monthly Enrollment Reports - Medicaid issue a monthly enrollment trends report.
Contact Us

Louisiana State Medical Society

6767 Perkins Road, Suite 100
Baton Rouge, LA 70808

Ph: 800.375.9508 | 225.763.8500
Fax: 225.768.5601

publicaffairs@lsms.org
Quick Links
Join Now!
Member Login
About LSMS
Careers.LSMS.org
Policy Finder
Advertising Info
Membership Management Software Powered by YourMembership  ::  Legal