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Medicaid Managed Care Transportation Provider Issue Resolution (IB 21-2 revised 3.7.23)

Date: 03/08/23

Louisiana Healthcare Connections is sharing a revision made to Informational Bulletin 21-2 on March 7, 2023 around Medicaid Managed Care Transportation Provider Issue Resolutions.

The respective contacts for all plans have been updated. Information for Louisiana Healthcare Connections and our transportation broker, MTM / Veyo, is included below. Information for other health plans can be accessed in the Louisiana Department of Health Informational Bulletin 21-2. 

For issues related to transportation claims, contact:

Transportation provider issue escalation and resolution – claim appeals:

An appeal must be received from the provider within 180 calendar days of the Remittance Advice paid date or original denial date. A determination will made by the broker within 30 days of receipt.

  • Contact provider support online
  • Email: Amber Dalcourt, Vendor Account Manager, adalcourt@mtm-inc.net, and Divonne Wiliams, Vendor Account Manager, divwilliams@mtm-inc.net
  • Mail to: Veyo, 3016 19th Street, Metairie, LA 70002

Issue Escalation

LDH and MCOs recognize there will be instances when a provider may desire to escalate issue resolution to the attention of LDH or the MCOs’ executive teams. While the above chart is specific to claim issue resolution, the following options are available for resolution of all issue types, including claims. If a provider is unable to reach satisfactory resolution or get a timely response through the MCO escalation process, direct contact with LDH is also an option.

Formal Complaint

  • Phone: 1-866-595-8133
  • Email: providercomplaints@louisianahealthconnect.com
  • Mail: Louisiana Healthcare Connections, P.O. Box 84180, Baton Rouge, LA 70884

Management Level Contacts

  • Candace Kliesch, Director of Operations, Candace.H.Kliesch@louisianahealthconnect.com 

Executive Level Contacts

  • Joe Sullivan, COO, Joe.M.Sullivan@louisianahealthconnect.com

LDH Escalation Contacts

If a provider is unable to reach satisfactory resolution or receive a timely response through the MCO escalation process, contact LDH using the information below.

  • How to Submit: E-mail LDH at MedicaidTransportation@la.gov

Always include details on attempts to resolve the issue at the MCO level, as well as contact information (contact name, provider name, e-mail and phone number) so that LDH staff can follow up with any questions.

Independent Review

In conjunction with the above claim dispute grid, Independent Review is another option for resolution of claim disputes. The Independent Review process may be initiated after claim denial.

Note: Per House Bill No. 492 Act No. 349, an adverse determination involved in litigation or arbitration or not associated with a Medicaid enrollee shall not be eligible for independent review.

  • The Independent Review process was established by La-RS 46:460.81, et seq. to resolve claims disputes when a provider believes an MCO has partially or totally denied claims incorrectly.
  • An MCO’s failure to send a provider a remittance advice or other written or electronic notice either partially or totally denying a claim within 60 days of the MCO’s receipt of the claim is considered a claims denial.
  • Independent Review is a two-step process which may be initiated by submitting an Independent Review Reconsideration Request Form to the MCO within 180 calendar days of the
  • Remittance Advice paid, denial, or recoupment date. Request forms are available on MCO websites or at the link below.
  • If a provider remains dissatisfied with the outcome of an Independent Review Reconsideration Request, the provider may submit an Independent Review Request Form to LDH within 60 calendar days of the MCO’s decision. Request form available at the link below.
  • Effective Jan. 1, 2018 there is a $750 fee associated with an independent review request. If the independent reviewer decides in favor of the provider, the MCO is responsible for paying the fee. Conversely, if the independent reviewer finds in favor of the MCO, the provider is responsible for paying the fee.
  • SIU post-payment reviews are not considered claims denials or underpayment disputes, therefore, SIU findings are exempt from the Independent Review Process.
  • Additional detailed information and copies of above referenced forms are available on the LDH Independent Review page.