Physician Billing for Louisiana Practices

We handle billing for solo independent physicians, single- and multi-specialty groups, independent practice associations, physician-owned surgical and procedural practices, hospital-affiliated faculty practice plans, office-based ambulatory physicians, telehealth physician groups, and locum or coverage physicians across New Orleans, Baton Rouge, Shreveport, Lafayette, and the surrounding parishes. New physicians joining an established Louisiana group get their credentialing, CAQH, and PECOS enrollment tracked from the offer letter forward, so the first claim is billable on day one rather than sitting in a holding queue. Groups billing across office and hospital sites get consistent POS handling so non-facility and facility rates never cross, procedural practices get global-period tracking that separates bundled post-op care from genuinely billable visits, and locum or coverage physicians get the reassignment and Q6 handling that keeps temporary staffing from creating denied claims. Whatever the model, the aim stays the same: every eligible encounter captured, coded to the level the record supports, and paid at the correct Louisiana rate.

Louisiana delivers Medicaid through Healthy Louisiana, and after its most recent procurement the program runs through six managed-care plans — Aetna Better Health, AmeriHealth Caritas Louisiana, Healthy Blue, Louisiana Healthcare Connections, UnitedHealthcare Community Plan, and Humana Healthy Horizons. Because the state expanded Medicaid in 2016, a large share of every practice's schedule now flows through those plans, so confirming plan assignment and eligibility before the encounter is the single most reliable way to keep a professional-fee claim clean. On the Medicare side, Part B claims are adjudicated by Novitas Solutions under Jurisdiction JH, the contractor serving a broad southern region, whose local coverage rules and conversion-factor changes move the professional fee year to year.

Commercially, Blue Cross Blue Shield of Louisiana carries a dominant book statewide alongside UnitedHealthcare, Humana, Aetna, and Cigna, and Medicare Advantage penetration adds prior-authorization and retrospective-review pressure across the metros. The anchor systems shape referral flow in each market — Ochsner Health and LCMC Health in New Orleans, Our Lady of the Lake and the Franciscan Missionaries network in Baton Rouge, Willis-Knighton and Ochsner LSU Health in Shreveport, and Ochsner Lafayette General in Acadiana — but between them independent single- and multi-specialty groups and IPAs still own their revenue cycle. For those practices, the money is won on front-end discipline in a high-Medicaid market: verifying plan and enrollment before the visit, securing authorizations, and defending high-level E&M with a decision-making or time note that stands on its own.

In a high-Medicaid market with six competing plans, preventable denials rarely come from exotic problems; they repeat across a full schedule until they add up. The table shows the leaks we close first.