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Questions, Disputes and Reconsiderations

Date: 01/28/21

Louisiana Healthcare Connections is dedicated to being your partner in providing care to our members. Having your questions answered thoroughly and any disputes resolved quickly is important to us and we are here to help. 

Claim Disputes 

Providers who disagree with a claim payment can request payment reconsideration from Louisiana Healthcare Connections by taking the following steps:

  • First Level Appeal - Providers can first request Claim Reconsideration in writing by filing a Provider Claim Dispute Form. We recommend that providers include all supporting documentation and utilize a trackable mail service to ensure receipt. Disputes must be filed within 180 calendar days of date of the initial Explanation of Payment (EOP). 
  • Second Level Appeal - Providers still unsatisfied with the results of claim reconsideration may file a second appeal using the Provider Claim Dispute Form within 90 calendar days of reconsideration response.

Independent Reconsideration 

Providers may complete an Independent Reconsideration Review form and submit it via mail or secure email. 

Providers have 180 days from one of the following dates to request reconsiderations from Louisiana Healthcare Connections: 

  • The date on which Louisiana Healthcare Connections transmits the remittance advice or other notice electronically, OR
  • Sixty (60) days from the date the claim was submitted to Louisiana Healthcare Connections if the provider receives no notice from Louisiana Healthcare Connections, either partially or totally, denying the claim, OR
  • The date on which Louisiana Healthcare Connections recoups monies remitted for a previous claim payment.

Louisiana Healthcare Connections will acknowledge receipt of the Independent Review Reconsideration form in writing within 5 calendar days and will render a decision within 45 days of receipt.

If providers are unsatisfied with the outcome of the reconsideration results, providers may request an independent review with a third party panel, by completing the LDH Independent Review Form. Please attach or enclose all supporting documentation, and submit via mail to the address below:

  • LDH/Health Plan Management
    P.O. Box 91030, Bin 24 
    Baton Rouge, LA  70821-9283
    Attn: Independent Review

Providers may also visit "Questions, Disputes and Resolutions" for additional information.