Louisiana Medicaid Management Information System (LMMIS)
Contents
1. Home Implementation of December 1 2010 Rate Reductions for Free Standing ESRD Facilities 12 3 10 Medical Equipment amp Supplies Implementation of December 1 2010 Rate Reductions for Lab Radiology and ASCs 11 30 10 Pay For Performance Pharmacy amp Prescribing Implementation of December 1 2010 Rate Reductions for Early Steps Providers 11 30 10 Providers LOrawidar Enralimant Cmarzansau Dulas Nanambhar 9940 Daimhureamant Data Darictinne 44 90 40 Implementation of Obstetrical Delivery Rates 12 3 10 Once on this page click the Provider Login button This will take you to the Provider Login Page Date Revised 01 07 2010 Precert Inquiry Application User Manual 2 2 Provider Login For Technical Support call Provider Login toll free 1 877 598 8753 b n K E Ss G Please enter your 10 digit National Provider Identifier NPI or 7 Digit Medicaid TI Provider ID ofthis ste or the information NOTICE TO USERS contained herein is prohibited by the Louisiana Department of Health and 7 i Hospitals This is Louisiana s Medicaid information and is the property of Molina and Department of Health and Hospitals It is for authorized use only Users authorized or unauthorized have no explicit or implicit expectation of privacy Any or all uses of this website and all files on this system may be intercepted monitored recorded copied audited inspected and d2. Precert Inquiry Search for a Louisiana Medicaid Recipient Hospital Stay Recipient s Medicaid ID Number Recipient s Date of Birth I Fmwov Date of Service CO kenen Denotes required field Warning Unauthorized use of this site or of the information contained herein is prohibited by the Louisiana Department of Health and Hospitals Molina Medicaid Solutions 2010 All Rights Reserved Date Revised 01 07 2010 Precert Inquiry Application User Manual 2 7 Troubleshooting If you require assistance in accessing the Precert Inquiry Application on www lamedicaid com contact Molina Technical Support Help Desk at 1 877 598 8753 toll free To access step by step instructions for web registration or establishing a login password for the secure web portal download the instructions at the following link http www lamedicaid com provweb1 Provweb_ Enroll Web Registration pdf Date Revised 01 07 2010 Precert Inquiry Application User Manual 3 0 USING THE APPLICATION 3 1 Precert Navigation The Precert Navigation displays the user s provider number name and login Louisiana Medicaid Logged In As Provider Login ePrecert Precert Inquiry Click the Main Menu link to go back to the Provider Applications Area Click the Logout button to logout of Provider Applications Area and go back to LAMedicaid com 3 2 Precert Inquiry Home Page Enter the Recipient s Medicaid ID or CCN Number
3. 644 03 THRT PREM LABOR ANTEPART Status Approved Days Approved 2 Print Response Letter Reason Codes Reason Code 408 HIPAA Reason Code Description RECON HAS BEEN REVIEWED ONLY A PORTION OF THE DAYS NEEDED HAVE BEEN APPROVED THE REMAINDER HAVE BEEN DENIED YOU NOW NEED MD TO MD CONFERENCE 3 Received 12 3 2009 1300 Level Of Care GEN Diagnosis 644 03 THRT PREM LABOR ANTEPART Status Approved Days Approved 3 Print Response Letter 4 Received 12 7 2009 1400 Level Of Care GEN Diagnosis 644 03 THRT PREM LABOR ANTEPART Status Approved Days Approved 3 Print Response Letter 5 Received 12 10 2009 1100 Level Of Care GEN Diagnosis 644 03 THRT PREM LABOR ANTEPART Status Approved Days Approved 3 Print Response Letter 6 Received 12 15 2009 1100 Level Of Care GEN Diagnosis 644 03 THRT PREM LABOR ANTEPART Status Rejected Days Approved 0 Reason Codes Reason Code 410 HIPAA Reason Code 090 Description SUBMITTED DOCUMENTATION SHOULD INCLUDE PERTINENT INFORMATION FROM THE 48 HRS PRIOR TO THE LAST APPROVED DATE 7 Received 12 21 2009 1100 Level Of Care GEN Diagnosis 644 03 THRT PREM LABOR ANTEPART Status Approved Days Approved 3 Print Response Letter 8 Received 12 23 2009 1100 Level Of Care GEN Diagnosis 644 03 THRT PREM LABOR ANTEPART Status Approved Days Approved 3 9 Received 12 30 2009 1400 Level Of Care GEN Diagnosis 644 03 THRT PREM LABOR ANTEPAR
4. submitted by your facility and standardized medical criteria However an approval is not a guarantee of the recipient eligibility Payment on a claim will only be made when the claim is billed correctly and all conditions for payment are met Reason codes if any are listed below SINCERELY BUREAU OF HEALTH SERVICES FINANCING This fax document is the property of Molina Medicaid Solutions and may contain restricted or confidential information It is intended only for the person s to whom it is addressed If it is not addressed to you it has been received in error If you have received it in error please notify the Molina Medicaid Solutions Privacy Officer immediately by faxing the document to 225 924 6179 and destroy any other copies This is an example of a Precert Letter from the Initial Date Revised 01 07 2010 13 Precert Inquiry Application User Manual 3 8 Precert Case Details Extension Information 1 Louisiana Medicaid Main Menu Logout Logged In As Provider Login ePrecert Precert Inquiry Return To Search Initial Request LEIES Extensions Extensions 1 Received 11 23 2009 1600 Level Of Care GEN Diagnosis 644 03 THRT PREM LABOR ANTEPART Status Denied Days Approved 0 Print Response Letter Reason Codes Reason Code 146 HIPAA Reason Code 083 Description DOCUMENTATION REFLECTS CARE COULD BE RENDERED IN AN ALTERNATE CARE SETTING 2 Received 11 30 2009 1200 Level Of Care GEN Diagnosis
5. 010 Response Time Military 1533 Reviewing Nurse E Reviewing Physician Status A1 Certified Approved Days 2 Reason Codes HIPAA Reason Code N A Fax Reason Code 063 Description PLEASE NOTE THIS IS A NEW CASE NUMBER FOR THIS ADMISSION Warning Unauthorized use of this site or of the information contained herein is prohibited by the Louisiana Department of Health and Hocnitale This is another example of Precert Details showing Initial Information Date Revised 01 07 2010 Precert Inquiry Application User Manual 3 11 Precert Case Details Extension Information 2 Louisiana Medicaid Logged In As Provider Login ePrecert Precert Inquiry Logout Return To Search Initial Request LEIES Extensions Extensions 1 Received 1 8 2010 1300 Level Of Care GEN Diagnosis 644 03 THRT PREM LABOR ANTEPART Status Rejected Days Approved 0 Print Response Letter Reason Codes Reason Code 311 HIPAA Reason Code 082 Description MEDICAL DOCUMENTATION DOES NOT SUPPORT INTENSITY OF SERVICE 2 Received 1 13 2010 1400 Level Of Care GEN Diagnosis 644 03 THRT PREM LABOR ANTEPART Status Approved Days Approved 2 Print Response Letter 3 Received 1 15 2010 1600 Level Of Care GEN Diagnosis 644 03 THRT PREM LABOR ANTEPART Status Approved Days Approved 1 Print Response Letter Reason Codes Reason Code 359 HIPAA Reason Code Description THIS APPROVAL BRINGS YOU TO YOUR DOCUMENTED DISC
6. HARGE DATE Warning Unauthorized use of this site or of the information contained herein is prohibited by the Louisiana Department of Health and Hospitals Molina Medicaid Solutions 2010 All Rights Reserved This is another example of Precert Details showing Extension Information Date Revised 01 07 2010
7. ST FOR HOSPITAL PRE ADMISSION CERTIFICATION AND LOS ASSIGNMENT Phone 1 800 877 0666 Fax 1 800 717 4329 NOTE This form must be completed in full to be considered for review by Molina ype 03 Acute Care Request Type Initial Request Level Of Care GEN Precert Number as Recipient Medicaid ID Recipient Age Sex ii Date of Birth Medicare Part A Benefits Exhausted Last Name i Hospital Medicaid ID Contact Person Phone Number Attending Physician ID Admit Date Actual Anticipated 111 166 Discharge Date 12 11 2009 If this is a transfer from another facility enter the transferring facility Medicaid ID or facility name below Fax Nb lt r RT Admit Time Military Time DIAGNOSIS ICD 9 CM Description Admitting Primary 644 03 HRT PREM LABOR ANTEPART Other Surgery Date CT Procedure Code s ICD 9 CM Precert Response View Response Letter Response Date 11 23 2009 Response Time Military 1344 Reviewing Nurse iE Reviewing Physician Status Al Certified Approved Days 2 Warning Unauthorized use of this site or of the information contained herein is prohibited by the Louisiana Department of Health and Hospitals Click the View Response Letter link in order to print the Precert Letter Click the Return To Search button in
8. T Status Approved Days Approved 3 Print Response Letter 10 Received 1 4 2010 1300 Level Of Care GEN Diagnosis 644 03 THRT PREM LABOR ANTEPART Status Rejected Days Approved 0 Print Response Letter Reason Codes Reason Code 131 HIPAA Reason Code 015 Description START AND DISCONTINUE DATES AS ORDERED BY MD FOR MEDICATIONS ANDTREATMENTS ARE NEEDED ON PCFO2 ABSTRACT DO NOT SEND MARS UNLESS REQUESTED Reason Code 149 HIPAA Reason Code ES Description SEND SUPPORTING MEDICAL DOCUMENTATION FROM LAST The Precert Extension page allows users to print and view the extension letter Each Precert can have up to 10 extensions Precerts with more than 10 extensions are also available online Date Revised 01 07 2010 14 Precert Inquiry Application User Manual 3 9 Precert Letter Extension Molina Medicaid Solutions Pre Certification Department P O Box 14849 Baton Rouge LA 70809 Date 1 7 2011 State of Louisiana Department of Health and Hospitals Bureau of Health Services Financing P O Box 91030 Baton Rouge LA 70821 9030 Sent To Recieved From Provider Sender Molina Medicaid Solutions Voice Phone SE Pre Certification Department Fax Phone Voice Phone 1 800 877 0666 Fax Phone 1 800 717 4329 CASE NUMBER RECIPIENT NUMBER RECIPIENT NAME UNISYS REVIEWER ID PHYSICIAN CONSULT PROVIDER NAME PROVIDER NUMBER REVIEW DATE 12 7 2009 REVIEW TIME 1140 DEAR PROVIDER This letter is pro
9. X DEPARTMENTOF HEALTH MOLINA AND HOSPITALS MO Solutions Medicaid Louisiana Medicaid Management Information System LMMIS Precert Inquiry User Manual Date Created 1 1 1 1 2010 Date Modified 01 11 2011 Prepared By Technical Communications Group Precert Inquiry Application User Manual Molina Medicaid Solutions and the Louisiana Department of Health and Hospitals Proprietary Data Notice The information contained in this document is proprietary to Molina and the Louisiana Department of Health and Hospitals The information in this document shall not be reproduced shown or disclosed outside Molina or Louisiana DHH BHSF without written permission Information contained in this document is highly sensitive and of a competitive nature NO WARRANTIES OF ANY NATURE ARE EXTENDED BY THIS DOCUMENT Any product and related material disclosed herein are only furnished pursuant and subject to the terms and conditions of a duly executed license or agreement to purchase services or equipment The only warranties made by Molina if any with respect to the products programs or services described in this document are set forth in such license or agreement Molina cannot accept any financial or other responsibility that may be the result of your use of the information in this document including but not limited to direct indirect special or consequential damages Exercise caution to ensure the use of this information and
10. der Applications 5 2 6 Precert Inquiry Home Page seen 6 D Ge N oI el E Keo d WE 7 3 0 USING THE APPLICATION nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn annnm 8 314 Pr ecert Navi gati M NEE 8 3 2 Precert Inquiry Home Page 8 AA Precert Inquiry Error MessageS sssssssssssnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn 9 AA Precert Inquiry Search Results 1 10 3 5 Precert Inquiry Search Results 2 11 Ap Precert Case Details Initial Information 12 3 7 Precert Letter Ter EE 13 3 8 Precert Case Details Extension Information 14 3 9 Precert Letter Extension x nssssciscdcccccccccces cies cassccecesccececasesaseccecccneseseverssanencse 15 3 10 Precert Case Details Initial Information 2 16 3 11 Precert Case Details Extension Information 2 17 Date Revised 01 07 2010 jii Precert Inquiry Application User Manual 1 0 OVERVIEW The Precert Inquiry Application located on www lamedicaid com allows providers to find Precert
11. ecert Inquiry Application User Manual 2 0 ACCESSING THE APPLICATION In order to access the Precert Inquiry Application open www lamedicaid com in a web browser Below is the LA Medicaid Home Page Note If you have problems accessing the Provider Inquiry Application refer to section 2 7 Troubleshooting further assistance 2 1 LAMedicaid com Home Page ulate fai For Technical Support Welcome to the Louisiana Medicaid Provider Support Center call toll free Search LAMedicaid el Den L 4 Pediatric Critical Care Codes Omitted from 9 22 amp 10 6 Physician Claim Adjustments 01 04 11 CommunityCARE 2 0 Provider Notice 1 06 11 Procedure Codes Payable to Optometrists 01 04 11 AcutePrecert 2011 HCPCS Update 01 04 11 About Medicaid Dental Procedure Code Policy Revision Update Effective 1 1 11 12 29 10 Billing Information CCN C dinated C E E NPI Paper Changes 12 23 10 Cer Attention Non Physician Providers 12 23 10 Recovery Request Dental Providers CommunityCARE Quality Profiles 12 23 10 Disaster EDLInformation Anesthesia Providers Recycle of Specified OB Claims 12 20 10 EHR Incentives FAQ ClaimCheck News and Editing Updates 12 16 10 Fee Schedules EE New Program Greater New Orleans Community Health Connection GNOCHC 11 18 10 Helpful Humbers New CPT codes added to RUM program 12 3 10 HIPAA Billing Instructions amp Companion Guides HIPAA Information Center
12. isclosed to authorized site Department of Health and Hospitals and law enforcement personnel as well as authorized officials of other agencies both domestic and foreign By using this system the user consents to such interception monitoring recording copying auditing inspection and disclosure at the discretion of authorized site or Department of Health and Hospitals Unauthorized or improper use of this website may result in administrative disciplinary action and civil and criminal penalties By continuing to access this website you indicate your awareness of and consent to these terms and conditions of use LOG OFF IMMEDIATELY if you do not agree to the conditions stated in this warning Document Provider Login On the Provider Login page enter your Provider ID and click the Enter button This will take you to the NPI Reminder Page Date Revised 01 07 2010 Precert Inquiry Application User Manual 2 3 NPI Implementation Reminder EE NPI Implementation Reminder 1 877 598 8753 Our records indicate you have registered your NPI with LMMIS This is a reminder that you should be billing your electronic claims with your registered NP to ensure claims will be processed orrectly If you are an individual provider and have an individual NP and an organizational NP please ensure both numbers are registered with Louisiana Medicaid Please download the NPI Warning Unauthorized use of this site or
13. lication Date Revised 01 07 2010 Precert Inquiry Application User Manual 2 5 Restricted Provider Applications For Technical Support call Provider Applications Area toll free 1 877 598 8753 The application s listed below are for authorized use only Click on an application link to access the application Provider Applications Warning Unauthorized use LAMEDICAID _COM Fact Sheet of this site or the information contained herein is prohibited by the Louisiana Department of Health and Claim Check Hospitals S Clear Claim Connection Restricted Provider Applications Provider Locator Information TPL Provider Notice to Pursue Difference Claim Status Inquiry Electronic Health Records Incentive Payment System Provider Ownership Enrollment ePrecert For Acute Care Initial Requests LAMEDICAID COM Fact Sheet Medicaid Eligibility Verification System National Provider Identifier Provider Locator Information gt Precert Inquiry ePrecert for Acute Care Initial Requests Uncompensated Care Costs EDI Submission Application EDI In the Restricted Provider Applications list click the Precert Inquiry link in order to access the Precert Inquiry Application This link will take you to the Precert Inquiry Home Page Date Revised 01 07 2010 Precert Inquiry Application User Manual 2 6 Precert Inquiry Home Page Louisiana Medicaid Logged In As Provider Login ePrecert
14. mple of a Precert Letter from the Extension Date Revised 01 07 2010 Precert Inquiry Application User Manual 3 10 Precert Case Details Initial Information 2 Louisiana Medicaid Logout Logged In As Provider Login ePrecert Precert Inquiry Return To Search STATE OF LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS BUREAU OF HEALTH AND HOSPITALS MEDICAL ASSISTANCE PROGRAM REQUEST FOR HOSPITAL PRE ADMISSION CERTIFICATION AND LOS ASSIGNMENT Phone 1 800 877 0666 Fax 1 800 717 4329 NOTE This form must be completed in full to be considered for review by Molina ype 03 Acute Care Request Type Initial Request Level Of Care GEN Precert Number RT Recipient Medicaid ID Recipient Age a Sex ii Date of Birth Medicare Part A Benefits Exhausted IT Last Name First Name MI Hospital Medicaid ID lt gt O Admit Time Military Time d Attending Physician ID Admit Date Actual Anticipated 12 11 2009 Discharge Date 12 16 2009 If this is a transfer from another facility enter the transferring facility Medicaid ID or facility name below 11TH EXT 22 DAYS DIAGNOSIS ICD 9 CM Admitting 644 03 THRT PREM LABOR ANTEPART Primary Other Surgery Date CT Procedure Code s ICD 9 CM Precert Response View Response Letter Response Date 1 7 2
15. or software material complies with the laws rules and regulations of the jurisdictions with the respect to which it is used The information contained herein is subject to change without notice upon DHH approval Revisions may be issued to advise of such changes and or additions Molina is a registered trademark of Molina Medicaid Solutions Copyright 2011 Molina Medicaid Solutions All rights reserved Date Revised 01 07 2010 i Precert Inquiry Application User Manual PROJECT INFORMATION Document Title Louisiana Medicaid Management Information System LMMIS Precert Inquiry Application User Manual Author Technical Communications Group Molina Medicaid Solutions LMMIS QA pm S Ceserpton ot change ml sn Date Revised 01 07 2010 ii Precert Inquiry Application User Manual TABLE OF CONTENTS 1 0 HEEN 1 1 41 Precert Inquiry Home Page 1 2 0 ACCESSING THE 40 04 0 1 2 2 1 LAMedicaid com Home Page 2 PAP E A E alo EE A 2 3 NPI Implementation Reminder 4 2 4 Provider Applications Area 4 2 5 Restricted Provi
16. order to go back to the Precert Inquiry Home Page Date Revised 01 07 2010 Precert Inquiry Application User Manual 3 7 Precert Letter Initial Molina Medicaid Solutions Pre Certification Department P O Box 14849 Baton Rouge LA 70809 Date 1 7 2011 State of Louisiana Department of Health and Hospitals Bureau of Health Services Financing P O Box 91030 Baton Rouge LA 70821 9030 Sent To Recieved From Provider Sender Molina Medicaid Solutions Voice Phone Pre Certification Department Fax Phone Voice Phone 1 800 877 0666 Fax Phone 1 800 717 4329 CASE NUMBER RECIPIENT NUMBER RECIPIENT NAME UNISYS REVIEWER ID PHYSICIAN CONSULT PROVIDER NAME PROVIDER NUMBER REVIEW DATE 11 23 2009 REVIEW TIME 1344 DEAR PROVIDER This letter is provided to confirm that request for Admission Certification and LOS assignment for the above patient was received 11 20 2009 and has been processed according to agency procedures for approvals or denials as indicated below Approved a maximum of 2 day s of inpatient stay from admit date 11 19 2009 through discharge date 11 21 2009 The date of discharge is not an approved day and is not included in the approved days Primary diagnosis code given was 64403 There must be a medical necessity for each day of the stay The patient should be discharged on the day the Discharge Criteria are met Admission certification and Length of Stay assignment are based on patient data
17. ospital stay Date Revised 01 07 2010 10 Precert Inquiry Application User Manual 3 5 Precert Inquiry Search Results 2 Louisiana Medicaid Logged In As Provider Login ePrecert Precert Inquiry Search for a Louisiana Medicaid Recipient Hospital Stay Recipient s Medicaid ID Number or CCN RE Recipient s Date of Birth COCO O O 00 Date of Service COCO O co Search clear Form Denotes required field Medicaid Recipient Medicaid 1D Rn TI Ace Rm en Date of Birth Last Name FirstName Rn TI SW Precert Number Admit Date Discharge Date Status Approved Days 11 19 2009 12 11 2009 Approved 12 11 2009 12 16 2009 Approved Warning Unauthorized use of this site or of the information contained herein is prohibited by the Louisiana Department of Health and Hospitals Molina Medicaid Solutions 2010 All Rights Reserved For physicians this summary information above is all the information available For facilities the user can click the Precert Number in order to the view the Precert details Date Revised 01 07 2010 11 Precert Inquiry Application User Manual 3 6 Precert Case Details Initial Information 1 Louisiana Medicaid Main Menu Logout Logged In As Provider Login ePrecert Precert Inquiry Return To Search Initial Request STATE OF LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS BUREAU OF HEALTH AND HOSPITALS MEDICAL ASSISTANCE PROGRAM REQUE
18. partment of Health and Hospitals Molina Medicaid Solutions 2010 All Rights Reserved When the user specifies information for a valid Precert the application will show the Recipient and the Precert information on the page Date Revised 01 07 2010 Precert Inquiry Application User Manual 3 4 Precert Inquiry Search Results 1 Louisiana Medicaid Logged In As Provider Login ePrecert Precert Inquiry Search for a Louisiana Medicaid Recipient Hospital Stay Recipient s Medicaid ID Number or CCN RE Recipient s Date of Birth COCO O O Date of Service COo o O Denotes required field Medicaid Recipient Medicaid ID RE TI Age Rn ss en Date of Birth a WEE I vun l Precert Number Provider Name Admit Date Discharge Date Status Approved Days ES 0 1 2010 10 4 2010 Approved 3 Warning Unauthorized use of this site or of the information contained herein is prohibited by the Louisiana Department of Health and Hospitals Molina Medicaid Solutions 2010 All Rights Reserved Recipient fields included are Medicaid ID name date of birth sex and age Precert fields included are Precert number Provider name admit date discharge date anticipated Precert status and approved days The discharge date is not an approved day If the Precert has more than 10 extension requests then the application will display all Precert numbers connected with the h
19. s for a specific recipient on a specific date of service This document will explain how to access and use the Precert Inquiry Application 1 1 Precert Inquiry Home Page The Precert Inquiry Application is available on www lamedicaid com The application is available to the following provider types 19 Doctor of Osteopathy DO and Doctors of Osteopathy DO Group 20 Physician MD and Physician MD Group 31 Psychologist 59 Neurological Rehabilitation Unit Hosp 60 Hospital 64 Mental Health Hospital Free Standing 65 Rehabilitation Center 69 Hospital Distinct Part Psychiatric Unit For physicians the application will only allow users to view the summary information of a Precert For facilities the application will allow users to view the summary and details of a Precert while also allowing users to print Precert letters Louisiana Medicaid Main Menu Logout Logged In As Provider Login ePrecert Precert Inquiry Search for a Louisiana Medicaid Recipient Hospital Stay Recipient s Medicaid ID Number or CCN Recipient s Date of Birth Ne Gd Date of Service MM DD YYYY Search clear Form required field Denote Warning Unauthorized use of this site or of the information contained herein is prohibited by the Louisiana Department of Health and Hospitals Molina Medicaid Solutions 2010 All Rights Reserved Date Revised 01 07 2010 1 Pr
20. the Recipient s Date of Birth and the Date of Service and click Search in order to find a Precert Click the Clear Form button in order to reset the form and search again Louisiana Medicaid Main Menu Logout Logged In As Provider Login ePrecert Precert Inquiry Search for a Louisiana Medicaid Recipient Hospital Stay Recipient s Medicaid ID Number or CCN E Recipient s Date of Birth Mm DD YYYY Date of Service MM DD YYYY Cear Clear Form quired field Denotes re Warning Unauthorized use of this site or of the information contained herein is prohibited by the Louisiana Department of Health and Hospitals Molina Medicaid Solutions 2010 All Rights Reserved The application will ensure that you enter valid data In the example below the application will inform the user what fields are not valid Date Revised 01 07 2010 8 Precert Inquiry Application User Manual 3 3 Precert Inquiry Error Messages Louisiana Medicaid Logged In As Provider Login ePrecert Precert Inquiry Search for a Louisiana Medicaid Recipient Hospital Stay e Recipient ID Required e Recipient Date Of Birth Required e Date Of Service Required Recipient s Medicaid ID Number or 666 F Recipient s Date of Birth IR Date of Service MM DD YYYY Denotes required field Warning Unauthorized use of this site or of the information contained herein is prohibited by the Louisiana De
21. the information contained herein is prohibited by the Louisiana Department of Health and Hospitals registration form by clicking on the link below complete the form and fax it to 225 216 6495 or call 25 216 6400 to register your organization number NPI Registration Form Continue to Login Page Document NPI Implementation Reminder Date Modified 4 04 08 On this page click the Continue to Login Page button This will take you to the Provider Application Area Page 2 4 Provider Applications Area For Technical Support call Provider Applications Area toll free 1 877 598 8753 z 2 R N The application s listed below are for authorized use only Click on an application link to access the application Warning Unauthorized use Provider Applications of this site or the information contained herein is LAMEDICAID COM Fact Sheet prohibited by the Louisiana Department of Health and Hospitals Restricted Provider Applications Please enter your Restricted Applications Login ID and Password Remember the Login ID and Password are case sensitive Login ID Password Forgot Your LoginID Forgot Your Password Forgot login ID and Password Document Provider Applications Area Date Modified 1 24 03 On this page enter your Login ID and Password and click the Login button This will display all the provider applications to which you have access including the Precert Inquiry App
22. vided to confirm that request for Continuance of Stay for the above patient was received 12 3 2009 and has been processed according to agency procedures for approvals or denials as indicated below Approved a maximum of 3 day s of inpatient stay from continuance date 11 23 2009 through discharge date 11 26 2009 The date of discharge is not an approved day and is not included in the approved days Primary diagnosis code given was 64403 Admission date given was 11 19 2009 There must be a medical necessity for each day of the stay The patient should be discharged on the day the Discharge Criteria are met Admission certification and Length of Stay assignment are based on patient data submitted by your facility and standardized medical criteria However an approval is not a guarantee of the recipient eligibility Payment on a claim will only be made when the claim is billed correctly and all conditions for payment are met Reason codes if any are listed below SINCERELY BUREAU OF HEALTH SERVICES FINANCING This fax document is the property of Molina Medicaid Solutions and may contain restricted or confidential information It is intended only for the person s to whom it is addressed If it is not addressed 10 you it has been received in error If you have received it in error please notify the Molina Medicaid Solutions Privacy Officer immediately by faxing the document to 225 924 6179 and destroy any other copies This is an exa
Download Pdf Manuals
Related Search