Home care billing · LA
Home care billing in Louisiana
Short answer
Home care billing in Louisiana turns on prior authorization and the EVV record behind it. Long Term Personal Care Services bill the LDH fiscal intermediary only after post authorization, granted once the EVV check-in and check-out match the units released for that week.
Community Choices Waiver claims carry a PA from the support coordinator's plan of care, home health needs e-PA for extended and adult visits, and from December 1, 2025 LDH checks fee-for-service claims against EVV records. Every claim has 12 months from the date of service. A dedicated Remitwright biller works the PA, the EVV match and the filing clock, serving Louisiana agencies remotely. Rules for other states are on the home care billing by state page.
Last reviewed by the Remitwright billing team. Editorial policy
Key facts for Louisiana home care billing
| Fact | In Louisiana | Source |
|---|---|---|
| Programs that pay | Community Choices Waiver (0866.R02.00); Long Term Personal Care Services (LT-PCS), Medicaid State Plan; Adult Day Health Care Waiver (0121.R08.00); New Opportunities Waiver (0401.R04.00); Residential Options Waiver (0472.R03.00); Supports Waiver (0453.R03.00) and Children's Choice Waiver (0361.R04.00) | 1 |
| How it is delivered | Managed care and fee-for-service, with waiver services outside the plans | 5 |
| EVV | Open vendor model | 2 |
| Medicare home health and hospice | Palmetto GBA, Jurisdiction M | 8 |
Programs that pay for home care in Louisiana1
Community Choices Waiver (0866.R02.00)
Personal assistance services, monitored in-home caregiving, nursing, skilled maintenance therapy, adult day health care, caregiver temporary support, support coordination, transition intensive support coordination and transition services, assistive devices and medical supplies, assistive technology, environmental accessibility adaptation, home delivered meals, housing stabilization and housing transition or crisis intervention services, and financial management services, for people 65 and older and people with physical disabilities ages 21 to 64 who meet a nursing facility level of care.
The Office of Aging and Adult Services (OAAS) oversees it. The support coordinator writes the plan of care with the planning team and the data contractor issues the prior authorization from it (Medicaid Services Manual Chapter 7). A person approved for LT-PCS cannot receive Community Choices Waiver services at the same time.
Long Term Personal Care Services (LT-PCS), Medicaid State Plan
Assistance with activities of daily living, and with instrumental activities when the plan of care calls for it, for Medicaid beneficiaries who meet nursing facility level of care and face imminent nursing facility admission, delivered by an agency holding an HCBS license from the LDH Health Standards Section.
An optional state plan HCBS benefit rather than a waiver (Medicaid Services Manual Chapter 30). It can run alongside the Adult Day Health Care Waiver or the Supports Waiver, but not with the Community Choices Waiver or PACE. Payment is per quarter hour, and every week of units needs post authorization through EVV before it bills.
Adult Day Health Care Waiver (0121.R08.00)
Adult day health care, health status monitoring, activity and sensor monitoring, support coordination, transition intensive support coordination and transition services, assistive technology, home delivered meals and a personal emergency response system, for people 65 and older and people with physical disabilities ages 22 to 64 who meet a nursing facility level of care.
Beneficiaries on this waiver can also receive LT-PCS, with the support coordinator coordinating the two; shared LT-PCS for more than one beneficiary at a time runs through this waiver and bills separately per beneficiary.
New Opportunities Waiver (0401.R04.00)
Individual and family support, monitored in-home caregiving, skilled nursing, nurse consult, supported independent living, substitute family care, day habilitation, prevocational services, individual and group supported employment, center-based respite, support coordination, specialized medical equipment and supplies, financial management services, adult companion care, community life engagement development, dental services, environmental accessibility adaptations, housing stabilization and housing stabilization transition services, one-time transitional services, personal emergency response, and dietician, psychologist and social worker services, for people with autism, intellectual disabilities or developmental disabilities ages 3 and older who meet an ICF/IID level of care.
Residential Options Waiver (0472.R03.00)
Monitored in-home caregiving, community living supports, shared living services, host home, companion care, skilled nursing, nursing consult, adult day health care, day habilitation, prevocational services, supported employment, out-of-home respite, support coordination, assistive technology and specialized medical equipment and supplies, financial management services, community life engagement development, dental services, environmental accessibility adaptations, housing stabilization and housing stabilization transition services, one-time transitional services, personal emergency response system, professional services and community access transportation, for people with autism, intellectual disabilities or developmental disabilities of any age who meet an ICF/IID level of care.
Supports Waiver (0453.R03.00) and Children's Choice Waiver (0361.R04.00)
The Supports Waiver covers day habilitation, habilitation, prevocational services, respite, support coordination, supported employment, specialized medical equipment and supplies, community life engagement development, dental services, housing stabilization and transition services and a personal emergency response system for adults 18 and older with autism, intellectual or developmental disabilities who meet an ICF/IID level of care. Children's Choice covers center-based respite, support coordination, specialized medical equipment and supplies, financial management services, family support and family training, environmental accessibility adaptations, housing stabilization and transition services and aquatic, art, music, sensory integration, hippotherapy and therapeutic horseback riding therapies for children and young adults ages 0 to 20 at the same level of care.
Supports Waiver beneficiaries access LT-PCS separately through the state plan, with the support coordinator fitting it into the daily schedule.
How the program is delivered
Both, with waiver services outside the plans. The 2024 CMS state tables list Healthy Louisiana as a statewide MCO program under 1915(b) and 1932(a) authority since February 1, 2012, with mandatory enrollment for most groups including aged, blind or disabled children and adults; its benefit grid marks home health and state plan personal care as plan benefits and leaves HCBS waiver services out, so waiver claims and LT-PCS stay fee-for-service with the LDH fiscal intermediary.5 Six plans take part: Aetna Better Health of Louisiana, AmeriHealth Caritas Louisiana, Healthy Blue, Humana Healthy Horizons, Louisiana Healthcare Connections and UnitedHealthcare Community Plan, with Maximus Health Services as enrollment broker and pre-assignment for members who do not choose. The Home Health chapter of the Medicaid Services Manual has the Bureau of Health Services Financing determine medical necessity for fee-for-service beneficiaries and the MCO for its own enrollees, and the Personal Care Services chapter has LT-PCS providers bill the LDH fiscal intermediary once post authorization is granted.
Electronic visit verification
Open vendor model. LT-PCS workers check in and check out through the Louisiana Services Reporting System (LaSRS) or another EVV system approved by the Bureau of Health Services Financing and OAAS; EVV is mandatory for LT-PCS, and release of the prior authorization depends on post authorization through the EVV record. Home health agencies and EPSDT-PCS agencies must use the system LDH designates or an alternate that has passed data integration with it and been approved by LDH, and reimbursement may be withheld or denied from an agency that does not.2 Informational Bulletin 25-29, as Louisiana Healthcare Connections republished it on October 8, 2025, says LaSRS is provided at no cost by LDH, that a third-party EVV vendor is the alternative, and that from December 1, 2025 LDH validates fee-for-service home health and EPSDT-PCS claims against EVV records by service code, date of service and beneficiary, applying one of six edit codes (370, 450, 518, 651, 700 or 744) when there is no match; the provider aligns the claim with its service records, corrects it and resubmits. The Personal Care Services manual adds that where two claims overlap, the provider whose EVV data was not manually added or edited has priority for payment. CMS lists Louisiana as compliant with the Cures Act for personal care EVV by January 1, 2021 and for home health EVV as of January 1, 2024.
Services under EVV2
- Long Term Personal Care Services (LT-PCS), where EVV is mandatory and post authorization runs through the EVV record
- EPSDT Personal Care Services, where the agency uses EVV for time and attendance tracking and billing
- Home health skilled nursing, therapy and home health aide visits, tracked for time, attendance and billing under the Home Health chapter
- Fee-for-service home health and EPSDT-PCS claims, validated against EVV records from December 1, 2025 under Informational Bulletin 25-29
Authorizations
Prior authorization in weekly units. For LT-PCS the applicant passes the Level of Care Eligibility Tool screen for nursing facility level of care and imminent admission, then a face-to-face interRAI assessment; the plan of care is written by the OAAS designee, the Long Term Care Access contractor notifies the chosen provider, and the data contractor issues a PA specific to the beneficiary, provider, service code, units and dates. Units release weekly, a week runs from midnight Sunday to 11:59 pm Saturday, units cannot move from one week to another, the program caps a beneficiary at 32 hours a week, and services without a current PA are not reimbursed, with no exceptions.2 Re-assessments happen at least every 18 months. EPSDT-PCS is prior authorized by the Bureau of Health Services Financing or its designee for no more than six months at a time, on a practitioner's face-to-face assessment and plan of care. Community Choices Waiver services follow the same pattern, with the support coordinator writing the plan of care and the data contractor issuing a PA specific to beneficiary, provider, service code, units and dates (Chapter 7). Home health agencies request PA through the e-PA web application to the Prior Authorization Unit for extended skilled nursing, multiple same-day visits for members under 21, and all nursing and rehabilitation in a residential setting for adults 21 and older; faxed or mailed requests are not accepted, and evidence of the face-to-face encounter travels with the request (Chapter 23).
Where the claims go
Fee-for-service claims go to the LDH fiscal intermediary and must be filed within 12 months of the date of service; a claim involving Medicare must reach the Medicare contractor within 12 months of the date of service, and third-party claims reach Medicaid inside the same 12 months. Only a remittance advice showing the claim was processed earlier, or correspondence from the state or parish eligibility office about the claim, proves timely filing; screen prints of electronic remittance advice, postal receipts and carrier confirmations do not.7 Claims more than two years old need retroactive Medicaid certification, a successful Medicare or Social Security appeal with retroactive benefits, or a documented state error. LT-PCS bills the fiscal intermediary only after post authorization through EVV, and the claim date cannot precede the service date. EPSDT-PCS files on an 837P or CMS-1500 with the PA number, and denies under edits 191, 193 or 194 when the PA number is missing, the dates fall outside the PA or the units exceed it. Home health files a UB-04 or 837I with the authorized healthcare provider in form locator 76. Home health for a Healthy Louisiana enrollee goes to the member's plan, which determines medical necessity for its own enrollees, and state plan personal care sits in the plans' benefit grid, so the eligibility check decides the payer before an EPSDT-PCS claim is built.
Medicare home health and hospice in Louisiana
Palmetto GBA, the A/B MAC for Jurisdiction M, processes Medicare home health and hospice claims for Louisiana along with Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee and Texas, while its Part A and Part B work covers North Carolina, South Carolina, Virginia and West Virginia.8 On the Medicaid side the agency must be Medicare-certified for Medicare and Medicaid by the Licensing and Certification Unit of LDH's Health Standards Section, EVV is required for all home health services, Medicaid pays one visit per profession per day for adults 21 and older, and extended home health, multiple same-day visits and adult nursing or therapy in a residential setting need PA (Chapter 23). CMS lists Louisiana as compliant with the Cures Act home health EVV requirement as of January 1, 2024; the federal deadline was January 1, 2023.
Common rejections in Louisiana, and the fix
LT-PCS claim filed before post authorization
The fixThe PA releases only after the data contractor matches the EVV check-in and check-out to the units it authorized for that week. The biller confirms post authorization in the EVV system before the claim leaves, and chases missing or unmatched visits with the agency before the claim is built rather than after a denial.
Units billed outside the prior authorized week
The fixA PA week runs from midnight Sunday to 11:59 pm Saturday and units approved for one week cannot be combined with another. The biller bills each week against its own release, flags any week that runs past the approved units before billing, and asks the beneficiary to request a status change assessment when needs have grown.
EPSDT-PCS claim denied under edit 191, 193 or 194
The fixThe claim needs the PA number, dates inside the PA period and units within the approval; each miss has its own edit code. The biller pulls the current PA from the eligibility verification system before each claim is built, bills only inside it, and files the next PA request before the six-month authorization ends.
Fee-for-service home health or EPSDT-PCS claim fails the EVV edit
The fixSince December 1, 2025 LDH checks these claims against EVV records by service code, date of service and beneficiary and returns one of six edit codes when nothing matches. The biller compares the claim with the agency's service records, corrects the visit or the claim, and resubmits rather than appealing.
Home health claim for a Healthy Louisiana enrollee sent to the fiscal intermediary
The fixHome health is a plan benefit, and the member's MCO decides medical necessity for its own enrollees. The eligibility check records the plan on each date of service and the biller files to that plan under its contract, keeping the fiscal intermediary for fee-for-service members.
Extended home health or adult nursing visits billed without PA
The fixPA must be received before the service for extended skilled nursing, multiple same-day visits under 21, and all adult nursing and rehabilitation in a residential setting, and the request goes through e-PA with face-to-face evidence attached. The biller keeps the PA calendar with the agency's intake and flags a start date with no approval.
Late claim rejected for lack of accepted proof
The fixLouisiana Medicaid accepts only a remittance advice that shows earlier processing or correspondence from the state or parish eligibility office; screen prints and mailing receipts are refused. The biller keeps every remittance advice indexed by beneficiary and date of service so a resubmission inside the two-year window carries the proof it needs.
Remitwright serves Louisiana home care and home health agencies remotely, inside the agency software you already use, with a dedicated biller.
FAQ
Questions from Louisiana agencies
Our LT-PCS prior authorization was approved, so why did the claim deny?
Can we carry unused LT-PCS hours into the next week?
Do we have to use LaSRS, or can we keep our own EVV system?
What changed for fee-for-service home health and EPSDT-PCS claims on December 1, 2025?
Do Community Choices Waiver claims go to the health plan or to Medicaid?
How do we prove a Louisiana Medicaid claim was filed on time?
Which programs pay for home care in Louisiana?
Which services fall under EVV in Louisiana?
Which Medicare contractor pays home health and hospice claims in Louisiana?
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