Managed Care Entity Resources

Reporting and Accountability

All contractors, including the managed care organizations (MCO), dental benefit program managers (DBPM) and the enrollment broker, must meet the requirements of their contract with the Louisiana Department of Health. If the contractor is deficient or non-compliant with these requirements, administrative actions, monetary penalties and sanctions may be assessed. 

The summary or reports below is compiled from data submitted by managed care entities. Additional reports also can be found here including:

• Healthy Louisiana Claims Reports
• Mental Health Parity and Addiction Equity Act Compliance Plan
• Enrollment Reports
• EQR Reports
• HEDIS Measures
• Transparency Report
• Diabetes and Obesity Report
• Medical Loss Ratio (MLR) Reports
• Encounter Data Reconciliation Reports

Louisiana Medicaid Contract Non-Compliance

Louisiana Medicaid managed care contractors must meet the requirements of their contracts with LDH. If a contractor is non-compliant with contract requirements, LDH may apply administrative actions or assess monetary penalties and intermediate sanctions to obtain the level of performance required for successful operation of the managed care program.

Guides and Manuals for Managed Care Entities

• Marketing and Member Education Companion Guide
• State Fair Hearing Companion Guide (Updated 6.25.14)
• System Companion Guide
• Salesforce Quick Reference Guide
• Salesforce MCE User Guide

Resources

• Encounter Inquiry/Review Request
• Health Plan Advisories
• Informational Bulletins
• Managed Care Access Monitoring Framework
• Medicaid Services Chart
• Medicaid State Plan
• Prevalent Languages