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Useful Managed Care Information | Louisiana Department of Health

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Useful Managed Care Information | Louisiana Department of Health


Independent Review

This process was established by La-RS 46:460.81, et seq. to resolve claims disputes when a provider believes a managed care organization (MCO) has partially or totally denied claims incorrectly. A MCO’s failure to send a provider a remittance advice or other written or electronic notice either partially or totally denying a claim within 60 days of the MCO’s receipt of the claim is considered a claims denial. SIU post-payment reviews are not considered claims denials or underpayment disputes, therefore, SIU findings are exempt from the Independent Review Process. Except per Act 204 of the 2021 Regular Legislative Session, mental health rehabilitation (MHR) service providers have the right to an independent review of an adverse determination by a managed care organization that results in a recoupment of the payment of a claim based on a finding of waste or abuse.

Effective Jan. 1, 2018 there is a $750 fee associated with an independent review request. If the independent reviewer decides in favor of the provider, the MCO is responsible for paying the fee. Conversely, if the independent reviewer finds in favor of the MCO, the provider is responsible for paying the fee.

Remember to send in the Independent Review Reconsideration Form to the MCO before you ask LDH for an Independent Review. Each MCO has the form on their site but you can also access it here.

Independent Review Process 




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Louisiana State Police provide update on officer-involved shooting in Gonzales

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Louisiana State Police provide update on officer-involved shooting in Gonzales


Louisiana State Police released updated information regarding an officer-involved shooting March 5 in Ascension Parish.

According to an LSP news release, the preliminary investigation found that a Gonzales Police Department officer conducted a traffic stop at around 10:45 p.m. near the intersection of South John Street and Orice Roth Road.

In the release, LSP identified the driver of the vehicle as 21-year-old Anthony Talbert of Baton Rouge, who was accompanied by a female passenger.

During the stop, Talbert allegedly reached toward a firearm that was inside the vehicle, per the release.

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The officer responded by discharging a department-issued firearm one time, which grazed both Talbert and the unidentified female, the release continued.

According to police, Talbert then fled the scene, exceeding 100 miles per hour and disregarding multiple traffic controls.

Troopers reported Talbert was taken into custody following a short pursuit.

He was booked into the Ascension Parish Jail on charges of aggravated flight, reckless operation, obstruction of justice and possession of a firearm in the commission of a felony, police said in the release.

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Per troopers, the female was transported to a hospital and was treated for minor injuries.

LSP’s initial news release reported no officers were injured.

According to police, the investigation remained active and further information would be released as available.

Michael Tortorich is a journalist for the USA Today Network in Louisiana.

Gonzales Weekly Citizen and Donaldsonville Chief, part of the USA Today Network of Louisiana, cover Ascension Parish and the greater Baton Rouge area. Follow at facebook.com/WeeklyCitizen and facebook.com/DonaldsonvilleChief.

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Should Shreveport homeowners buy earthquake insurance in Louisiana?

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Should Shreveport homeowners buy earthquake insurance in Louisiana?


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  • A 4.9 magnitude earthquake, the strongest in Louisiana’s onshore history, struck near Shreveport.
  • Standard homeowner’s insurance policies typically do not cover earthquake damage.
  • Property owners can purchase add-on earthquake coverage, which is generally inexpensive in low-risk areas like Louisiana.
  • Despite the low cost, the deductible for earthquake insurance is usually high.

Thursday’s earthquake that shook furniture and rattled pipes in the Shreveport region may have some property owners wondering whether they should consider buying insurance to cover them from potential stronger movement in the future.

The 4.9 magnitude earthquake that struck just north of Coushatta at 5:30 a.m. March 5 was the strongest onshore event in Louisiana history.

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No structural damage has been reported from Thursday’s earthquake so far, but the strength of the movement may have been enough to raise concern.

“If people are concerned they should call their insurance agent and explore pricing and options,” Louisiana Insurance Commissioner Tim Temple said in an interview with USA Today Network.

“It’s not an issue that has come up often in Louisiana, but if coverage can alleviate anxiety and risk it’s absolutely something homeowners and property owners should consult their agent about,” he said.

Earth movement or subsidence insurance is generally excluded from homeowners’ policies, as is flood insurance, but property owners can secure the coverage through their insurers as an add-on, called an endorsement.

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Eugene Montgomery, owner of Community Financial Insurance Center in northern Louisiana, said a subsidence endorsement to cover earthquake damage would generally be inexpensive in Louisiana because of the low risk.

“The coverage itself is inexpensive, but the deductible would be high,” Montgomery told USA Today Network.

That’s the case for one Shreveport homeowner who asked not to be identified. The homeowner secured a subsidence endorsement following Thursday’s earthquake that cost $120 per year after discounts with a 10% deductible.

Republican state Sen. Adam Bass, who also operates an Allstate agency in Bossier, said most people won’t buy an add-on that’s not required by their mortgage holders no matter how inexpensive it is.

Bass said he hasn’t had any inquiries about earth movement insurance during his career.

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But Montgomery said he remembers a temporary spike in those policies in 1990 when climatologist Iben Brown predicted a major earthquake would strike the New Madrid Fault in Missouri on Dec. 3 of that year, a forecast that flopped.

“It really created a little bit of a panic,” Montgomery said. “Everybody wanted insurance for a short period of time.”

Montgomery doesn’t expect a similar run on earthquake after Thursday’s event, but said he won’t be surprised if some level of interest increases.

“When people can actually feel the earth moving it gets their attention,” he said.

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Greg Hilburn covers state politics for the USA TODAY Network of Louisiana. Follow him on Twitter @GregHilburn1.



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Louisiana delegation responds with mixed reaction to leadership change at DHS

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Louisiana delegation responds with mixed reaction to leadership change at DHS


WASHINGTON (WAFB) — President Donald Trump has removed Kristi Noem as secretary of the Department of Homeland Security and nominated Sen. Markwayne Mullin to replace her. Noem will take on the role of Special Envoy for the Shield of the Americas. Members of Louisiana’s congressional delegation responded to the change in leadership.

FILE – Homeland Security Secretary Kristi Noem appears for an oversight hearing before the Senate Judiciary Committee, at the Capitol in Washington, March 3, 2026. (AP Photo/J. Scott Applewhite, File)(J. Scott Applewhite | AP)
FILE - Sen. Markwayne Mullin, R-Okla. speaks during a Senate Armed Services Committee hearing,...
FILE – Sen. Markwayne Mullin, R-Okla. speaks during a Senate Armed Services Committee hearing, Jan. 14, 2025, on Capitol Hill in Washington.(Jacquelyn Martin | AP Photo/Jacquelyn Martin, File)

Kennedy clash preceded removal

Noem led DHS since the beginning of Trump’s second term. One of the most noted controversies of her tenure was the department’s spending of $220 million on television ads across the country, which drew scrutiny from Sen. John Kennedy during a committee hearing.

“Did the President know you were going to do this?” Kennedy asked during the hearing.

“Yes,” Noem replied.

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Kennedy said the spending and other issues had weighed on him.

“You just add all of this up and the other turmoil and it’s been stuck in my craw,” Kennedy said. “I want to secure the border and I want to enforce our immigration laws, but I’m tired of trying to explain behavior that is inexplicable to me.”

Louisiana delegation reacts

Congressman Cleo Fields wrote on X that Noem “was not qualified to lead one of the most critical agencies in our federal government, and her tenure made it clear that she was not the right person for this role,” adding that “there is far too much at stake for anything less than exemplary leadership.”

Congressman Troy Carter, who held a congressional hearing in New Orleans regarding DHS issues, said that under Noem’s leadership, DHS and ICE “repeatedly carried out aggressive immigration operations without proper coordination with local leaders, disregarded due process, and created fear and instability in communities that deserve respect and protection under the law.”

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Sen. Bill Cassidy said on social media that “securing the border is one of President Trump’s greatest achievements” and that he looks forward “to continue that success and ensure FEMA delivers for Louisiana families.”

(Source: ASSOCIATED PRESS, POOL, U.S. SENATE TV, U.S. DEPARTMENT OF HOMELAND SECURITY, U.S. IMMIGRATION AND CUSTOMS ENFORCEMENT)

As with all cabinet positions, Mullin will need to go through Senate confirmation to gain the cabinet seat. It is unclear when confirmation hearings will take place.

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