Louisiana Health Plan

1
Louisiana Health Plan

• Louisiana Mandated Service Charge Coding

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LHP History

• Louisiana Health Plan (LHP), formerly Louisiana
  Health Insurance Association, was created in 1990
  and effectuated in January of 1991 to administer
  the High Risk Pool (R.S. 22213.2 22231)
• LHP also administers the HIPAA Pool which was
  established in 1998

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LMSC Overview

• The Louisiana Mandated Service Charge (LMSC) was
  implemented in 1991 with the creation of LHP to
  act as a funding mechanism for the High Risk Pool
  (La R.S. 22239 22241)
• Since 2001 the LMSC has generated over 700,000
  annually

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LMSC Overview Contd

• Providers bill every eligible patient 2 per
  eligible inpatient day and 1 per eligible
  outpatient admission
• Insurers pay the billed fees directly to LHP
• Both Providers and Insurers submit reports
  regarding the LMSC to LHP

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LMSC Coding

• Originally the 071 revenue code was used
• In 2003, under HIPAA the 071 revenue code became
  outdated
• The Facility Tax Amount in Loop 2400 was
  implemented to bill and pay the LMSC
• National Uniform Billing Committee (NUBC)
  determined this alternative method was
  inappropriate

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NUBCs Recommendation

• LMSC should be coded using a series of national
  Value Codes approved at the 02/25/03 NUBC meeting
  to accommodate surcharges aggregated by payer
• Codes are reported in the HI segment of loop 2300
  in the 837I using a qualifier code of BE

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NUBCs Recommendation Contd

• The Value Codes are AA, BA, CA
• The codes are defined as Regulatory Surcharges,
  Assessments, Allowances or Health Care Related
  Taxes for
• Payer A (AA) - Primary
• Payer B (BA) - Secondary
• Payer C (CA) - Tertiary

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Purpose of New Value Codes

• The use of these new Value Codes will allow for
  consistency between electronic and paper claims
  filing as well as achieving compliance under the
  HIPAA and NUBC guidelines.

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Implementation

• Start date for using the new value codes for
  billing and paying the LMSC is January 1, 2005
• All claims with submission dates on or after
  January 1, 2005 shall incorporate the new value
  codes for LMSC billing and paying
• Providers Insurers will be notified of these
  changes

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Questions????