Medicaid louisiana forms to be reimbursed

Getting Money Back for Medical Expenses

The team in charge of giving money back to people on Medicaid who pay for medical expenses themselves before they knew they had Medicaid is called the Recipient Reimbursement Unit. If you signed up for Medicaid on or after February 15, 1995, you might get money back for medical things you paid for between when you got approved for Medicaid and when you got your first Medicaid Eligibility Card (or when your card got reactivated).

Who Can Get Money Back?

To get money back you need to meet these rules:

1. You had Medicaid when you got the item or service.
2. The place you got the medical item or service was approved by Medicaid when you got it.
3. You got the item or service while you had Medicaid or beofre you got your Medicaid Eligibility Card.
4. You didn't already get money back from Medicaid or someone else.
5. The service or item was covered by Medicaid.
6. You have to show proof that you paid for it.

Things You Can't Get Money Back for:

• Bills you didn't pay yet.
• Bills you paid after you got your Medicaid Eligibility Card.
• Bills from places that aren't in the Medicaid program.

What You Need to Show

If you want to get money back, you need to show:

1. The bill with;

• Your name
• The doctor or facility's name, address and phone number
• Date of service
• Procedure and Diagnosis codes (you can ask your provider if you don't know this)
• How much you paid
• If private insurance paid, you need proof of what they paid, like an Explanation of Benefits (EOB)
• If you got Durable Medical Equipment (DME), you need a note from your doctor showing proof of medical necessity and a prescription for each item, if one was issued.
• If you got dental work, you need diagnosis and procedure codes for each tooth.
• If you got medicine, you need information about the prescription, including: the date the prescription was filled, the National Drug Code (NDC), quantity dispensed, and retail cash price, if insurance or discount card was used, or the amount paid by the third party entity.

And:

2. Proof you paid for the bill. IF it was paid by someone else, proof that you are still liable to pay back the person who paid the bill.

To request money back, send all of the information above to:

DHH/MMIS/Retroactive Reimbursement Unit

P.O. Box 91030

Baton Rouge, LA 70821-9030

or

Contact Number: 866-640-3905 or 225-342-1739

If they need more information from you, they'll send you a form to fill out. You have fifteen days to send back the inforamation. If you need more time, you can ask, but you can't get more than fifteen extra days. IF you don't send the information or ask for more time, they will not be able to give you money back.

If you follow all of the rules, they'll send you a check for the most Medicaid will pay, and they'll tell you why you're getting the money. The Notice of Recipient Reimbursement Decision explains the reimbursement decision. You will get back money at the Medicaid price, but they'll take out any payments made from someone else (like insurance) first.

If you do not follow the rules, a Notice of Reimbursement Decision will be sent to tell you why they are not going to give you money back. You can appeal the decision, if you think there was an error.

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Mailing Address: Louisiana Department of Health | P. O. Box 629 | Baton Rouge, LA 70821-0629
Physical Address: 628 N. 4th Street | Baton Rouge, LA 70802 | PHONE: 225-342-9500 | FAX: 225-342-5568
Medicaid Customer Service 1-888-342-6207 | Healthy Louisiana 1-855-229-6848