Managed Care Organization Provider Directory Project (IB 24-12)

Date: 05/02/24

Louisiana Healthcare Connections is sharing a bulletin letting providers know about a provider directory network adequacy project. (IB 24-12)

Network adequacy requirements are an integral part of each managed care organization’s (MCO) contract with the Louisiana Department of Health (LDH), and network adequacy is a fluid process that requires continuous oversight. LDH must ensure that Medicaid enrollees do not face challenges receiving healthcare services due to inadequate networks or incorrect directory information.

LDH has asked Louisiana Healthcare Connections and the additional MCOs to start a new project that will span six months, ending September 30, 2024, requiring each MCO to thoroughly review and make corrections to their network reporting in order to eliminate inaccurate or outdated information.

LDH requests that providers respond timely and completely to MCOs as they reach out to verify provider data, such as servicing location, contact information, specialty, terminated providers, etc. MCOs will also outreach to providers that no longer appear to be actively seeing Medicaid enrollees based on claims analysis.

Thank you in advance for assisting with this very important project that will improve the enrollee experience by facilitating access to healthcare.

Questions regarding this Informational Bulletin should be directed to Dana M. Johnson at Dana.Johnson@la.gov