Louisiana runs five Healthy Louisiana Medicaid plans, a workers' comp system built around a single authorization form, and clean-claim clocks that count business days, not calendar habits. A2Z Billings handles the coding, submission, and follow-up so your front desk stops absorbing that complexity.
Remote support for practices statewide — Shreveport to New Orleans, Lafayette to Monroe.
The deadlines Louisiana billing runs on
LAC 37:XIII.6009, Reg. 74
LAC 37:XIII.6007
R.S. 23:1203.1
R.S. 23:1203.1
LDH Provider Manual, Sec. 1.4
The environment
Healthy Louisiana closed out its UnitedHealthcare contract at the end of March 2026 and moved close to 280,000 members onto five remaining plans inside a six-week window. For billing staff, that meant re-checking eligibility on patients who looked routine the visit before, since the plan paying the claim could have changed without the patient noticing.
Aetna Better Health, AmeriHealth Caritas, Healthy Blue, Humana Healthy Horizons, and Louisiana Healthcare Connections each run separate prior authorization lists, portals, and provider files. A patient's MCO on record in January is not guaranteed to be the MCO paying the claim in April.
Blue Cross and Blue Shield of Louisiana holds the largest share of commercial coverage in the state, so most private-pay billing runs against its network edits and its Regulation 74 clean-claim clock, even when the card in front of you reads a different brand name underneath.
Novitas Solutions administers Louisiana's Part A and B claims alongside Arkansas, Colorado, Mississippi, New Mexico, and Oklahoma. Its local coverage determinations, not general CMS guidance, decide the documentation bar for pain injections, wound care, and imaging.
Care concentrates around New Orleans, Baton Rouge, Lafayette, and Shreveport. Delta and rural-parish practices often run a back office of two or three people covering five payer portals, and the gap widens every time one of them leaves.
Where the claim stall
Six failure points that are specific to Louisiana's billing environment.
Patients who were moved off UnitedHealthcare in the spring are still showing up with old cards and outdated authorizations. The claim looks correct. The plan on file is simply wrong.
Gainwell's provider file has to match what each MCO shows on its own roster. When an NPI, a taxonomy code, or a revalidation date falls out of sync, the claim denies for enrollment, not for anything the biller typed.
Under Regulation 74, a contracted electronic claim is payable in 25 days and a nonelectronic claim in 45. Practices resubmitting by hand routinely lose that window before anyone notices the aging report.
Once nonemergency treatment passes the $750 statutory threshold, the carrier has five business days to respond and the provider has ten to answer a follow-up request. A missed window on either side stalls treatment and the bill behind it.
Auto and general liability cases route through settlement negotiations that can run months longer than any Medicaid or commercial timeline, and without a dedicated tracker they age quietly in accounts receivable.
A practice fluent in Medicaid, Blue Cross, Novitas, and workers' comp systems is genuinely hard to find and harder to keep. A single vacancy can stall claim tracking across every payer at once.
How we handle it
Each leak above maps to something we actually do, not a general promise.
We recheck Healthy Louisiana enrollment before the visit, not just at intake, so a plan reassignment surfaces before the claim does.
We reconcile your Gainwell provider file against each MCO's roster on a set schedule, closing the gap before it produces a denial.
We split MCO authorization denials from Medicaid enrollment denials from Novitas coding denials, because each one needs a different form and a different appeal path.
We track every open Form 1010 and 1010A against its five- and ten-business-day clock and follow up before the window lapses.
We flag claims approaching the 365-day Medicaid limit or a payer-specific deadline weeks out, not after the denial letter arrives.
Services
Claims scrubbed against Blue Cross, all five Healthy Louisiana MCOs, and Novitas edits before submission.
CPT, ICD-10-CM, and HCPCS Level II coding checked against current Novitas LCDs and each MCO's policy updates.
Enrollment, revalidation, and CAQH maintenance handled separately across Medicaid, Medicare, and each commercial network.
Full-cycle oversight from eligibility check to posted payment, reported by payer and by plan.
Plan and MCO assignment confirmed before every visit, including patients moved since the UnitedHealthcare exit.
Requests tracked from submission through the payer's response window, Form 1010 included.
Appeals written to each payer's specific reconsideration process and deadline, not a generic letter.
ERA reconciliation checked against contracted Blue Cross rates, MCO fee schedules, and Medicare allowables.
Aging worked by payer and denial category, with Medicaid claims prioritised against their filing deadline.
Specialities
Louisiana practices face specialty-specific payer rules, authorization requirements, and coverage terms that can directly affect reimbursement.
Heavy prior authorization load for imaging and diagnostics, with chronic-condition documentation checked against MCO medical necessity rules.
Billing reconciled against each MCO's telehealth parity terms, which still vary plan to plan for rural patients.
Medicaid covers a large share of Louisiana deliveries, so global billing periods and postpartum coverage windows are tracked against each MCO's own terms.
Built around Form 1010 dependence, with liability and comp aging tracked separately from standard AR.
Visit-limit tracking across MCOs and comp carriers, with authorization renewals flagged before the count runs out.
EPSDT screening billing and FQHC enrollment obligations handled alongside standard Medicaid panel work.
We also bill for gastroenterology, dermatology, neurology, radiology, oncology, and urgent care practices across the state.
Revenue Cycle
Each stage exists to catch a denial category before submission, not to fix it after.
Why Outsource
Practices here are absorbing more administrative load than the schedule can fund on its own. The March 2026 Medicaid reassignment alone forced re-verification on thousands of established patients statewide.
Add a workers' comp process built on hard business-day deadlines and a rural staffing pool that's thin to begin with, and hiring one in-house biller to cover it all is a fragile plan. Outsourcing spreads that coverage across a team that already knows each portal, each deadline, and how they change.
Questions we get
We'll go through your last quarter of Louisiana claims, sort denials by payer and cause, and show you where the process is losing time before it starts losing money.