Louisiana cardiology groups work with a payer picture that keeps shifting. Medicaid plans have been leaving the state program, more than half of Medicare patients sit in Advantage plans, and every carrier has its own view of when a stress test or a cath needs approval. Cardiology Billing Services handles the claim work behind all of that, from the first eligibility check to the last unpaid balance.
We partner with general cardiologists, electrophysiologists and interventional groups throughout the state. We chase the denials, fix the coding and keep authorizations attached to the correct claims so your front desk and clinical staff aren’t doing that in between patients.
Healthy Louisiana is the state’s Medicaid managed care program, and its lineup has been shrinking. UnitedHealthcare has already left. Healthy Blue is leaving, pushing some 290,000 members toward the four remaining plans. Each reassignment can change who gets billed, what network applies and whether an old authorization still counts.
A patient with Healthy Blue last month could be with Humana or Aetna this month without even knowing it. We look at the plan on the date of service and update the record when it changes. This helps prevent claims from being sent to the wrong plan while the filing clock keeps ticking.
Our rule: Consider the treatment plan assignment something you should verify at each encounter, especially with patients who have just received a new member ID card.
These are the Healthy Louisiana plans identified for cardiology claims, including the plan transitioning out of the program.
Plan rosters change by state decision. Confirm the current lineup with the Louisiana Department of Health before establishing a payer-specific workflow.
| Managed care plans | Fee-for-service Medicaid |
|---|---|
| Each plan has its own provider portal, authorization rules, claim address and appeal route. We confirm the member’s plan first, then follow that plan’s process instead of one generic Medicaid routine. | A smaller group of patients stays in fee-for-service. Those claims run through the state’s fiscal intermediary, Gainwell, with eligibility and remittances on lamedicaid.com. We settle the coverage type before the claim is built. |
Billing providers are required to complete screening through Louisiana Medicaid’s provider enrollment portal, managed by Gainwell for the state. Enrollment can be deactivated, and revalidation is required every five years. Payment may be stopped if the NPI, taxonomy or service address in the portal does not match the information on claims.
State enrollment is separate from joining each Healthy Louisiana plan. The plans credential providers independently and generally recredential about every three years. We track both sets of deadlines so a lapse in one does not silently prevent payments from the other.
The enrollment and fee-for-service functions are covered by the state portal. Each managed care plan has its own portal for eligibility, authorizations and claim status, and those logins do not cross over.
Our staff keeps a log of which portal answers which question for each of your payers, so nobody burns twenty minutes searching in the wrong place.
Learn about Cardiology Billing Services →Authorization rules vary by plan and product, and they change. Louisiana Medicaid plans, commercial carriers and Medicare Advantage organizations each have their own requirements. We review the current list before the service is scheduled, then track the request through to a decision.
Nuclear stress tests, cardiac CT, coronary CTA and cardiac MRI are common candidates for review. Some plans send advanced imaging requests to a separate vendor instead of handling them directly.
Documentation requirements often apply to ablations, EP studies, elective heart caths, stents and device implants. We collect the notes and test results the reviewer will request.
We record the reference number, approved codes, facility, rendering physician and date range. A common denial reason is a claim that does not match its approval.
Reminder: An approval does not guarantee payment. Medical necessity and coding still matter, as does eligibility on the date of service.
In Louisiana cardiology practices, we deal with a mix of Medicare Advantage, Original Medicare, major commercial insurance companies and Medicaid. Each has its own rules for filing claims, referrals and appeals. Keeping track of all of them requires attention to each plan’s deadlines and processes. It is not always easy, but it is part of running the practice.
Health insurers like Blue Cross and Blue Shield of Louisiana, Aetna, Humana and UnitedHealthcare provide HMO, PPO and POS products. These products have rules for referrals and authorizations.
Louisiana’s prompt-pay laws, found in Title 22 of the Revised Statutes, set time limits for insurers to pay or reject claims.
Repeat echocardiograms and extended rhythm monitoring tend to draw policy limits, so we read the payer’s policy before those claims go out.
Louisiana is in Medicare jurisdiction H, administered by Novitas Solutions. Stress test, echo and monitoring coverage is addressed by Novitas local coverage determinations (LCDs), so diagnosis codes need to match the applicable policy. Original Medicare claims generally must be submitted within one calendar year of the service date.
Medicare Advantage matters here. About 57% of Louisiana Medicare beneficiaries are in those plans, each with its own network and authorization rules. For dual-eligible patients, we confirm which payer is primary.
Our coders read the note before they pick the codes. They check CPT, HCPCS and ICD-10-CM selection, modifiers and units, then run the claim against National Correct Coding Initiative edits. That catches bundling problems that would otherwise come back as denials weeks later.
Common work includes office visits, ECGs, echocardiograms, stress tests, Holter and event monitors, ablations, pacemaker and ICD services, heart catheterization, structural procedures and cardiac rehab.
How a service is billed depends on who owns the equipment and where the test is done. For the most part, the hospital bills the technical component, while the cardiologist who only interprets a test performed at the hospital bills the professional component with modifier 26. The practice can bill globally when it performs the service and owns or operates its own equipment, subject to applicable payer rules.
Getting that wrong can trigger recoupments. We check the place of service, the documentation and any contract terms before the claim leaves.
Coding rule: Modifiers follow what was actually done and what the payer allows, not what appeared on the last claim.
We tackle the revenue cycle in order, beginning with coverage checks before the visit and working on the oldest unpaid balances on the aging report. Give us the full cycle, or select the stages that cause the most trouble.
We verify a patient’s Medicaid, commercial, Medicare and Advantage coverage is active, the plan type, network status and whether authorization is required.
We identify payers’ current requirements, send clinical documents, track the decision and compare the approval to the scheduled service.
We check codes, modifiers, units and diagnosis links against the medical record.
Visits, tests and procedures from the schedule and notes are captured as complete charges, including lengthy EP and cath cases.
Before anything goes out, demographics, NPI and taxonomy, code pairs, authorization numbers and payer destination are checked.
We post ERAs and EOBs, reconcile payments and adjustments, and identify net balances.
Denial reasons are sorted, corrected claims or appeals go out, outcomes are tracked, and repeat causes are reported to your team.
We work aging buckets, call payers on stalled claims, pursue underpayments and maintain appeal files.
We support Medicaid portal enrollment, plan credentialing, Medicare and CAQH upkeep, commercial participation and revalidation dates.
A heart failure clinic and an EP lab do not generate the same claims. We set up the workflow around what your practice actually performs.
Office visits, ECGs, risk-factor management and routine follow-up.
Heart cath and PCI claims, with attention to modifiers, bundling edits and documentation.
Ablations, mapping, device implants and remote device monitoring.
Echo, stress testing and monitors, with global and split billing sorted out.
Perfusion imaging authorizations, isotope and supply charges, and claim review.
Cardiac CT, coronary CTA, MRI and the approvals that go with them.
TAVR and other structural procedures, with the documentation they demand.
Clinic visits, remote monitoring and related outpatient claims.
Session documentation, coding and payer limits on visit counts.
Most denials start early, either at registration or with an authorization that was never billed to the claim. This process is designed to catch those errors before the claim goes out.
Demographics and insurance are captured correctly the first time.
Active coverage, plan type, network and referral status are confirmed.
Requirements are checked and approvals are tracked.
Diagnoses, codes and modifiers are reviewed against the note.
Every billable service appears on the claim.
Edits are applied and the claim is routed to the right payer.
Payments, adjustments and balances are recorded.
Unpaid claims are researched, corrected, appealed and monitored.
Our team runs through this list on every claim. It also works as a starting point for your own front-end review, though payer rules vary.
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When a Medicaid plan leaves the program, members land on another plan and old authorizations may not carry over. We recheck the plan and request new approvals where needed.
Hurricanes can close offices, displace patients and cut off access to records and portals. We keep claim work moving remotely and watch filing deadlines during recovery.
Old addresses, taxonomy codes or group links in the state portal can hold up payment. We compare them against what your claims say.
For people with both Medicare and Medicaid, we confirm which payer goes first and whether the claim crosses over.
Heart disease causes roughly 12,000 deaths in Louisiana each year, and the state’s age-adjusted rate sits above 215 per 100,000 in CDC figures. That workload lands on busy metro hospitals and on rural parishes with long referral distances alike.
We work with cardiology practices in places such as:
Keeping up with Medicaid roster changes, Medicare Advantage rules and commercial policy updates is a job in itself. An outside billing team does that work daily, so your staff do not have to learn each change from a denial.
Front desk staff and nurses spend less time on hold with payers and more time with patients.
Healthy Louisiana plans, fee-for-service Medicaid, commercial carriers, Original Medicare and Advantage each follow their own process.
Denials, aging claims, underpayments and enrollment renewals get worked on a schedule instead of when someone finds a free hour.
Eligibility verification, authorization assistance, coding review, charge entry, claim submission, payment posting, denial work, A/R follow-up and credentialing assistance.
It is the state’s Medicaid managed care program, run by private health plans contracted by the Louisiana Department of Health. Some members are still in fee-for-service Medicaid.
The plans listed in this page are Aetna Better Health of Louisiana, AmeriHealth Caritas Louisiana, Humana Healthy Horizons in Louisiana, Louisiana Healthcare Connections and Healthy Blue of Louisiana. Healthy Blue is transitioning out of the program, and its members are expected to move to other plans. UnitedHealthcare has already left. Do not rely on any roster without checking with the state.
Use the provider enrollment portal run by Gainwell for the state through lamedicaid.com. You will need NPIs, taxonomy, license and group information. Credentialing is a separate step for each health plan.
Novitas Solutions administers Medicare Part A and Part B claims in Jurisdiction H. Applicable local coverage determinations establish coverage requirements for tests such as stress studies and monitoring.
Yes, often for advanced imaging, ablations and elective caths, but requirements depend on the payer, product and setting. We check the current policy before the service is scheduled.
Yes. Title 22 contains prompt-pay statutes that set time limits for health insurers to pay clean claims. Details vary by claim type and payer, and the rules do not apply in the same way to Medicare or self-funded employer plans.
Yes, depending on the scope we agree on. This can include portal enrollment, plan credentialing, CAQH upkeep and renewal tracking.
If denials are piling up, plan changes keep catching your staff off guard, or authorizations and claims never seem to match, we can look at your process and show you where money is slipping. Send your payer mix and a sample of recent denials, and we will start there.