Louisiana
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
A private organization entrusted with money intended to protect Louisiana from the cost of abandoned oil and gas wells used funds to make below-market loans benefiting a senior state regulator, his re…
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NEW ORLEANS (WVUE) – A driver died from a gunshot wound after a Louisiana State Police car chase in New Orleans Saturday evening (June 20), but troopers say they did not fire the gun.
Troop NOLA confirmed the car chase ended near Franklin Avenue and North Miro Street Saturday. Troopers said they found the driver shot and brought them to the hospital, where that person died.
The driver’s identity has not been released.
A Troop NOLA spokesperson said he could not confirm if anyone else was in the car, if anyone has been arrested, or if troopers found a gun.
A spokesperson said more details will be released as a state police force investigation continues.
Troop NOLA is a special investigation unit tasked with proactive policing, traffic enforcement and crime reduction.
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Copyright 2026 WVUE. All rights reserved.
MONROE, La. (KNOE) – Shelby Bordelon of Iberville Parish was crowned Miss Louisiana 2026 Saturday night in Monroe, earning the title and a $15,000 scholarship. Bordelon, a graduate student at Southeastern Louisiana University, said the role is about more than pageantry, emphasizing the yearlong service mission tied to the crown.
“Part of the mission of this organization is the service behind it,” Bordelon said. “And the service is so important, you are serving your state for a year… having the opportunities to connect with others… to continue making an impact and leaving my mark on others as well.”
Bordelon, who finished first runner-up in last year’s competition, said the moment her name was called as the winner still hasn’t fully sunk in.
“It was every emotion you could think of that was running through my mind at that moment,” she said, adding she focused on preparation and perspective this year. “I really wanted to go into this year with no regrets… just really trusting in that mindset and that plan.”
Bordelon said she hopes to use her platform to raise awareness for her nonprofit, Claire’s Promise, which focuses on combating drunk driving.
You can learn more about the nonprofit here. She will now represent Louisiana at the Miss America Pageant, which begins in late August in West Palm Beach, Florida.
Copyright 2026 KNOE. All rights reserved.
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