Your Louisiana Medicaid claims and revenue raw data may be obtained in an electronic text format by requesting the information from the Louisiana Department of Health. Below is the primary and secondary contact information and the request form. We have also included the form needed to request an MR0-14 summary report:
Primary Contact Info:
Ms. Sabrina ScottSecondary Contact Info:
Ms. Patnisha WilliamsThe Louisiana Department of Health has been approved by the Centers for Medicare and Medicaid Services (CMS) to make payments in the Physician's Supplemental Payment Program for all of the entities noted in the LA State Plan Amendment. The purpose of this program is to enhance payments to physicians employed or contracted by the public hospitals. Below are the requested forms and instructions necessary to participate in this program.
Please review the instruction documents prior to completing the submission forms. The Instruction documents outline the recommended approach to completing your submission as well as clarifications for frequently asked questions and examples.
FFS Instructions & Clarifications
[FFS] UPL Submission FormsEach submission must include completed LA Commercial Data Request and Certification Forms. These forms will need to be submitted annually to maintain eligibility within the Fee for Service [FFS] UPL program.
LA Commercial Data Request Form: The Practitioner Information and Submission Checklist tabs will need to be filed annually, while the Average Commercial Rate forms are filed on initial submission and then once every 3 years. Submission of these forms will only maintain eligibility under the FFS Program.
FFS LA Commercial Data Request Form FFS LA Certification Form Physician DisclosurePlease submit completed forms to LDH at: PhysicianUPL@LA.GOV
If your submission contains sensitive information and you need a secure portal to submit through, please contact us. If you prefer to submit by mail, our physical location is:
LeBlanc, Robertson, Chisholm and Associates, LLCFeel free to contact Brittany Fox at (337) 256-5202 with any questions or concerns.
The Louisiana Department of Health is gathering filings for potential Physician State Directed Payments. For physician groups who maintain an active Fee for Service (FFS) filing, there is an abbreviated filing process. The due date for Forms will be announced at a later date.
Submit completed forms to LDH: PhysicianUPL@LA.GOV
Feel free to contact Brittany Fox at (337) 256-5202 with any questions or concerns.
| Period | Reduction Factor | Payment |
|---|---|---|
| Prior to August 1, 2006 | 17.00% | 83.00% |
| August 1, 2006 - February 19, 2009 | 13.80% | 86.20% |
| February 20, 2009 - August 3, 2009 | 16.82% | 83.18% |
| August 4, 2009 - February 2, 2010 | 21.52% | 78.48% |
| February 3, 2010 - July 31, 2010 | 25.44% | 74.56% |
| August 1, 2010 - December 31, 2010 | 28.87% | 71.13% |
| January 1, 2011 - July 31, 2012 | 30.29% | 69.71% |
| August 1, 2012 - January 31, 2013 | 32.87% | 67.13% |
| February 1, 2013 - December 31, 2016 | 33.54% | 66.46% |
| January 1, 2017 - December 31, 2017 | 28.87% | 71.13% |
| January 1, 2018 - December 31, 2018 | 25.44% | 74.56% |
| January 1, 2019 - December 31, 2019 | 16.82% | 83.18% |
| January 1, 2020 - Current | 14.16% | 85.84% |