Durable Medical Equipment Ordering and Referring Provider Requirements (IB24-49)

Date: 12/16/24

Louisiana Healthcare Connections is sharing with providers requirements for Durable Medical Equipment Ordering and Referring Provider will have new implementation edits.

Louisiana Medicaid will implement claims and encounter system edits to ensure that the ordering and referring provider types for claim type 09 [(Durable Medical Equipment (DME)] are individuals, and are listed on the claim form. Ordering and referring providers are also required to be enrolled with the state in order for the claim to pay or encounter to be accepted. A group or clinic must not be listed as the ordering or referring provider on claims or encounters. For example, ordering and referring providers cannot be physician clinics, Federally Qualified Health Clinics, Rural Health Clinics, and American Indian Clinics.

Edit (047) for invalid or missing ordering provider will be educational for ordering or referring providers with a group or clinic NPI for 30 days from the date of this Informational Bulletin. The edit will then be set to deny claims and encounters that have a group or clinic NPI listed as the ordering or referring provider.

Louisiana Healthcare Connections will update our claims processing system to reflect this change within 30 calendar days of this published update. Claims will be automatically recycled, no action is needed by the provider.

For questions related to this information as it pertains to fee-for-service Medicaid claims processing, contact Gainwell Technologies Provider Services at (800) 473-2783 or (225) 924- 5040.