2021-27: Emergency Medical Services Eligibility & Claims during the COVID-19 Public Health Emergency

Date: 07/30/21

The Louisiana Department of Health released an update for emergency medical service eligibility claims during the COVID-19 Public Health Emergency (PHE).

Louisiana Medicaid assures services to certain non-citizens that are limited to treatment of emergency medical conditions, not related to organ transplant procedures. The Medical Eligibility Determinations Team reviews all emergency medical services (EMS) cases to establish whether emergency services were provided and for what duration. Prior to the COVID-19 PHE, EMS claims were only payable during the permitted dates of eligibility.

Due to the PHE, Medicaid implemented a temporary operating procedure in June 2020 to identify and process EMS claims throughout the PHE. The temporary procedure is to pend, not pay or deny, all claims for the EMS population. All claims not paid during the PHE continue to remain in a pended status.

The temporary operating procedure has been updated. For the remainder of the PHE, EMS claims will continue to pend for review. However, beginning August 1, 2021, pended EMS claims that have been reviewed and determined to be non-payable will be denied with error code 155 - EMS PHE.

The Medical Eligibility Determinations Team will continue to ensure proper claims processing, and claims denials may be reversed if future review determines emergency services were provided.

For questions, email the Medical Eligibility Determinations Team at MEDT@la.gov, or contact Kathryn Loechelt at (225) 219 – 0942 or Kathryn.loechelt@la.gov. Providers can find additional information on the Remittance Advice webpage.