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Louisiana Department of Health & Hospitals | Kathy Kliebert, Secretary

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Statewide Initiatives



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Reporting & Accountability

 

All Bayou Health contractors, including the five Health Plans and the Enrollment Broker, must meet the requirements of their contract with the Department of Health and Hospitals. If the contractor is deficient or non-compliant with these requirements, administrative actions, monetary penalties and sanctions may be assessed. Details of any administrative actions taken can be found here.

The summary or reports below is compiled from data submitted by the five Bayou Health Plans. Additional reports also can be found here including:

 

Prompt Payment

These reports identify claims received and processed by claim type including the average age of the claim when processed and dollar amount paid by the Health Plan.  Theses reports are used to assure compliance with the timely processing requirements outlined in the Bayou Health contracts.  The minimum standard for clean claims paid to be paid in less than 15 business days is  greater than or equal to 90 percent, and the minimum performance standard for clean claims to be paid in 30 days or less is greater than or equal to 99 percent.

Percent of Clean Claims Paid in Less Than 15 Business Days Percent of Clean Claims Pain in 30 Calendar Days of Less
Percent of Clean Claims Paid in Less Than 15 Business Days (Prepaid) 2nd Quarter 2013

Percent of Clean Claims Paid in Less Than 30 Calendar Days (Prepaid) 2nd Quarter 2013

Percent of Clean Claims Paid in Less Than 15 Business Days (Prepaid) 1st Quarter 2013 Percent of Clean Claims Paid in Less Than 30 Calendar Days (Prepaid) 1st Quarter 2013

Percent of Clean Claims Paid in 15 Business Days or Less (Prepaid) - 4th Quarter 2012 Percent of Clean Claims Paid in 30 Calendar Days or Less (Prepaid) - 4th Quarter 2012
   
Percent of Clean Claims Paid in Less Than 15 Business Days (Prepaid) 3rd Quarter 2012 Percent of Clean Claims Paid in Less Than 30 Calendar Days (Prepaid) 3rd Quarter 2012

Denied Claims

These reports provide a listing of denial reason codes, and the number of denials received that month for that particular code.  The report on the Shared Savings Health Plans only includes denials made directly by the Health Plan during pre-processing.  Additional denials may result from final adjudication by the Fiscal Intermediary (Molina).  Examples of denial reasons that would be files under the "All Other" category include terminations, duplicate claims and EOB charges that do not match claim.

Denied Claims By Prepaid Health Plan By Reason Denied Claims By Shared Savings Health Plan By Reason
Denied Claims By Prepaid Health Plan By Reason - 2nd Quarter 2013 Denied Claims By Shared Savings Health Plan By Reason - 2nd Quarter 2013

Denied Claims By Prepaid Health Plan By Reason - 1st Quarter 2013 Denied Claims By Shared Savings Health Plan By Reason - 1st Quarter 2013

   
Denied Claims By Prepaid Health Plan By Reason - 3rd and 4th Quarter 2012 Pre-Processing Denials By Shared Savings Health Plan By Reason - 3rd and 4th Quarter 2012

Emergency Room Utilization Rates

These reports represent Low and High Level Emergency Room Utilization Rates. Low Level Emergency Room Rates are determined by using CPT codes 99281 and 99282 while the High Level Emergency Room Rates are determined by using CPT Codes 99284 and 99285.  All rates are calculated based on the number of visits per 1,000 members in the Health Plans.

Low Level Emergency Rate By Health Plan - Jul 2012 to Jun 2013   High Level Emergency Rate By Health Plan - Jul 2012 to June 2013
Low Level Emergency Rate By Health Plan - 3rd and 4th Quarter 2012 and 1st and 2nd Quarter 2013 High Level Emergency Rate By Health Plan - 3rd and 4th Quarter 2012 and 1st and 2nd Quarter 2013