Out-of-Network Providers

For providers who are not contracted with Louisiana Healthcare Connections, we would love to have you join our network! All of the contracting and credentialing information you need is here for you to get started. This will make it easy for you to access your patient’s medical and billing histories, and get paid fully and quickly for your services.

How to become a Contracted Provider

It’s easy to become a contracted provider with Louisiana Healthcare Connections. Call toll free: (866) 595-8133 to learn how become a contracted provider to gain the full benefits of partnering with us, including:

  • A comprehensive approach to care for your patients through disease management programs, healthy behavior incentives and 24-hour toll-free access to bi-lingual registered nurses
  • Initial and ongoing provider education through orientations, office visits, training and updates
  • A dedicated claims team to ensure prompt payment
  • Minimal referral requirements and limited prior authorizations
  • A dedicated provider relations team to keep you informed and maintain support in person or by phone
  • The ability to check member eligibility, authorization and claims status online
  • Healthcare collateral for your patients (e.g., information about our benefits and services) and educational displays for your office

If you are not yet contracted with us but have patients who are members of Louisiana Healthcare Connections, here is some helpful information for working with us to care for your patients.

Authorizations and Surgeries

Authorizations for care and scheduled surgeries established prior to February 1, 2012 are loaded to our medical systems. You can obtain information and status updates for authorizations and surgeries by calling (866) 595-8133. If you submit prior authorizations via our website you can view them on our secure provider portal.

Payment to out-of-network providers

For services that meet the definition of emergency services, reimbursement to providers is 100% of the Medicaid rate for emergency services. For services that do not meet the definition of emergency services, reimbursement is at 90% of the published Medicaid fee-for-service rate in effect on the date-of-service.

Where and how they submit claims

  1. Electronic Claims: Providers may submit electronic claims to Louisiana Healthcare Connections through the following clearinghouses:
    • Emdeon
    • Availity
    • Gateway

    LHC Payer ID is 68069. For more information on electronic filing and what clearinghouses Louisiana Healthcare Connections has partnered with, contact:
    Louisiana Healthcare Connections
    c/o Centene EDI Department
    1-800-225-2573, extension 25525

    or by e-mail at:
    EDIBA@centene.com

    In addition, providers may submit claims electronically via our secure web portal if they register for its use by calling 866-595-8133.

  2. Paper claims: Initial claims, corrected claims and requests for reconsideration should be mailed to:Louisiana Healthcare Connections
    Attn: Claims Department
    P.O. Box 4040
    Farmington, MO 63640-3826
  3. Claim Disputes:
    Note: Please use the Claim Dispute Form.
    Attn: Claims Department
    P.O. Box 3000
    Farmington, MO 63640-3800

Where and how they obtain a prior authorization (PA)

Prior authorization should be requested at least seven calendar days before the scheduled service delivery date or as soon as need for service is identified. The primary care physician should contact our UM department via telephone (866-595-8133), fax or through our website with appropriate supporting clinical information to request an authorization. The fax number is 1-877-401-8175.

How they can file an appeal

An appeal is a request for review of a “notice of adverse action.” A “Notice of Adverse Action” is the denial or limited authorization of a requested service, including the type or level of service; the reduction, suspension, or termination of a previously authorized service; the denial, in whole or part of payment for a service excluding technical reasons; the failure to render a decision within the required timeframes; or the denial of a member’s request to exercise his/her right under 42 CFR 438.52(b)(2)(ii) to obtain services outside the Louisiana Healthcare Connections network. The review may be requested in writing or orally, however oral requests for appeals within the standard timeframe must be resolved within thirty (30) days of receipt of the appeal, with a fourteen (14) day extension possible if additional information is required. Members may request that Louisiana Healthcare Connections review the Notice of Adverse Action to verify if the right decision has been made.

Registering as a provider to use our web portal tools

Even if you are not a contracted provider, you can register with us to use our web portal tools. Please call (866) 595-8133 and ask for Provider Relations.