LAC 50:I.8301. Pay and Chase

A. Definition Claima single document line identifying the service and/or charges for services for a single recipient from a single provider. B. Medicaid claims for services covered under the State Plan will be cost avoided when there is probable third party liability unless the claim is for one of the following services: 1. primary preventive pediatric care diagnoses are confined to those listed under Diagnosis Codes Related to Preventive Pediatric Care Services at www.lamedicaid.com; a. Individuals under age 21 qualify; and b. Hospitals are not included and must continue to file claims with the health insurance carriers; 2. early and periodic screening, diagnosis and treatment (EPSDT) medical, vision, and hearing services; 3. EPSDT dental services; 4. EPSDT services to children with disabilities (formerly referred to as school-based health services) which result from screening and are rendered by school boards; 5. services which are a result of an EPSDT referral, indicated by entering "Y" in block 24H of the CMS-1500 claim form, sometimes called HCFA-1500, or "1" as a condition code on the UB-92 (form locators 24 through 30); and 6. services for Medicaid eligibles whose health insurance is provided by an absent parent who is under the jurisdiction of the state child support enforcement agency are subject to a “wait and see period” that was effective April 1, 2021. a. Wait and See—payment of a claim only after documentation is attached to a hard copy claim and submitted to the state’s fiscal intermediary demonstrating that 100 days have elapsed since the provider billed the responsible third party and remains to be paid. C. In processing these claims, the Medicaid agency will pay the claim and seek reimbursement from liable third parties, utilizing the claims method of payment called “pay and chase”.