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Stream RCM provides medical billing services in Louisiana for physicians, clinics and specialty groups. Healthcare providers in Louisiana get paid by Medicare, Medicaid plans and private insurance and each one has its own rules. We take care of the billing work your staff doesn’t have time for: coding, claims, payment posting, denials, A/R and credentialing. Your team gets more time with patients while we follow each claim until it’s paid or closed.
Imagine a Louisiana clinic’s front desk in early January. A patient who had Healthy Blue, a Medicaid plan, last year comes in for a checkup, but the plan no longer covers them. If no one checks, the claim goes to the wrong plan.
UnitedHealthcare left Healthy Louisiana on March 31, 2026. Healthy Blue exits on December 31, 2026, which leaves only four plans. In May 2026, about 1.39 million people had Louisiana Medicaid and most of them get care through a Healthy Louisiana plan. With two Medicaid plans leaving in one year, payer setup is now part of protecting revenue, not just a front-desk step.
Child Enrollees
Expansion Adults
Healthy Blue Share
Billing for a heart practice is very different from billing for a children’s clinic. In Baton Rouge, a cardiology group spends its time on imaging rules and prior auths. Over in Lafayette, a pediatric clinic deals with something else. Many of its young patients are on Medicaid or LaCHIP and their coverage can switch from one visit to the next. Our team bills for over 50 specialties. That includes family practice, behavioral health, oncology, wound care, orthopedics, radiology, urology, pulmonology, gastroenterology and physical therapy. So before your first claim goes out, our medical billers and coders get familiar with how you work. We’ll ask how your providers chart, which modifiers come up most and what your payers want approved first.
Practices looking for a medical billing company in Louisiana usually want proof before they sign. Our operations are 100% HIPAA compliant and the figures below are company-reported. Your own results will come down to your payer mix, how your providers document and where you’re starting from.
Stream RCM manages every stage of your revenue cycle, from patient registration to the last dollar posted. When you compare medical billing companies in Louisiana, look at what happens before and after the claim, not just the claim itself.
Patient Information
Insurance EligibilityClinical Coding
Complete Charge
Claim Preparation
Electronic Claim
Payment Posting
Denial Resolution
Revenue PerformancePlenty of claim problems begin at check-in. That's why we double check the basics before coding starts: name, birth date, member ID, who's responsible for the bill and whether there's a second insurance. Dual coverage needs extra attention in Louisiana. Close to 150,000 Louisianans were Qualified Medicare Beneficiaries (QMBs) as of May 2026. Under federal rules, you're not allowed to bill them for Medicare deductibles or coinsurance. We flag QMB status at intake. That stops wrong patient bills from going out and gets the Medicaid crossover claim set up correctly.
We confirm active coverage, plan assignment, copays, deductibles and authorization rules before the appointment. For Medicaid patients, that includes a fresh look in MEVS, the state's Medicaid eligibility system. According to LDH, Healthy Blue members' new plans will appear in MEVS by November 23, 2026. Those new plans apply to visits on or after January 1, 2027. So a December check might show the wrong plan for a January visit. Our team checks again at every visit.
Our medical coders go through the provider's notes line by line and pick the CPT, ICD-10-CM and HCPCS codes. Then they check modifiers and medical necessity before anything moves on. Louisiana Medicaid runs claims through Medicaid NCCI edits, the same as every other state. Private plans often use their own edit rules instead. A code pair that clears one payer can fail with the next. That gap trips up a lot of medical billing and coding in Louisiana. You'll see it most with bundled procedures and with modifiers 25 and 59.
Good care doesn't get paid if the charge never gets entered. We regularly hold each chart up against what actually got billed. Maybe a procedure or shot was done but never coded, or supplies were used and nobody charged for them. Add-on codes get missed too. We look for all of it. Misses like these happen more when a practice runs a few offices or has doctors seeing patients at more than one hospital. Charges come in late, or they end up in the wrong spot. When we spot a missed charge, we send it back to your staff with the chart note right there, so the fix doesn't take long and you can see what changed.
Each claim gets one last check before it goes out. We confirm the patient info, coverage, codes, rendering NPI, taxonomy, place of service and service location. Location matters for Medicare in Louisiana. Jefferson, New Orleans, Plaquemines and St. Bernard parishes are paid under the New Orleans locality. The other 60 parishes use Rest of Louisiana rates. If the service address is wrong, the claim can be priced on the wrong fee schedule. It's an easy mistake to miss and a hard one to fix later.
Clean claims go out electronically and are tracked through clearinghouse and payer acknowledgments. Each payer has its own path. For Medicare Part B, that's Novitas Solutions, which handles Louisiana as the Jurisdiction H contractor. Healthy Louisiana claims go to the patient's plan under that plan's payer ID. Fee for service Medicaid claims are processed by Gainwell Technologies, the state's fiscal intermediary. We work on rejections quickly so a claim doesn't sit unnoticed until a filing deadline is near.
We post every insurance payment, adjustment, patient balance, refund and recoupment. Then we match those entries to your bank deposits. Posting is also where underpayments show up. Louisiana Medicaid sets many professional fees as a share of the Louisiana Region 99 Medicare allowable, while each Healthy Louisiana plan pays under its own contract terms. We compare what was paid with what should have been paid and flag short payments for follow up instead of writing them off.
First, we figure out why each denial happened. Was it eligibility, a missing auth, coding, documentation or a late filing? Then we fix the step that caused it. When an appeal is supported, we file it and track it to a decision. Louisiana gives providers an extra option for managed care disputes. When an MCO denies a claim, you get 180 days from the remittance date to request an independent review reconsideration from the plan. If the plan keeps the denial, or doesn't answer within 45 days, you can take it to LDH for an independent review.
Our reports show your clean claim rate, denial trends, A/R aging, payer response times and collections, broken down by provider and location. Payer mix tracking matters in Louisiana. LDH counted 506,568 expansion adults on Medicaid in June 2025. By May 2026, that number was down to 386,487. If some of those patients now have marketplace coverage or no coverage at all, your self-pay balances may shift with them and the reports should show it early.
Doing billing in house costs more than salaries. You also pay for training, software, keeping up with payer changes and coverage when someone is out. When you outsource your medical billing to us most of those fixed costs become one service fee. Stream RCM medical billing services in Louisiana start at 2.99% of monthly collections. Here is how the two models compare.
| Billing Consideration | In-House Billing | Outsourced to Stream RCM |
|---|---|---|
| Staffing | Salaries, benefits, hiring, training and coverage gaps | A dedicated billing team with account support |
| Claim Performance | Depends on staff experience and internal checks | 99% clean claim rate reported by Stream RCM |
| Denial Management | Staff work appeals around daily tasks | Root-cause review, appeals and payer follow-up |
| Operating Cost | Fixed payroll, software and training costs | 40–50% cost savings reported by Stream RCM |
| Payer Updates | Staff track LDH bulletins and plan changes on their own | Our team monitors LDH, MCO and Medicare updates |
You work with one team for billing, coding, denials, A/R, credentialing and audits. You don’t have to manage separate vendors.
We prepare, review, submit, and track claims until Medicare, Medicaid, or private insurers issue payments or final decisions.
Our coders match notes to CPT, ICD-10-CM, and HCPCS codes, checking modifiers and payer edits before submitting claims.
We review denials, correct claim errors, and submit supported appeals through our denial management services to recover payments.
We prioritize aging balances by payer and amount, contact insurers about stalled claims, and track outstanding payments through resolution.
Our provider credentialing services manage CAQH, PECOS, Louisiana Medicaid enrollment, and MCO contracts so providers can start billing.
Coverage isn’t the same across Louisiana’s 64 parishes. Plan mix, enrollment size and Medicare locality all shape how claims should be set up. The counts below are Healthy Louisiana managed care members from LDH’s June 2026 enrollment report.
About 99,600 Healthy Louisiana members. Orleans uses Medicare's New Orleans locality, so the service address sets the fee schedule.
LDH reports Jefferson in two enrollment areas, with about 105,100 Healthy Louisiana members combined. Only East Baton Rouge has more.
No parish has more Healthy Louisiana members, about 111,100. Capital-area practices bill every plan in the program.
Shreveport's parish has about 68,200 Healthy Louisiana members and each plan there sets its own authorization rules.
Around 26,000 Healthy Louisiana members live here. Groups in Bossier and Caddo can use one billing process for both.
About 60,200 Healthy Louisiana members, the most in its LDH enrollment area, ahead of St. Landry and Iberia.
Lake Charles-area practices see about 51,800 Healthy Louisiana members and roughly 46% belong to Louisiana Healthcare Connections.
Nearly 29% of about 49,700 members here are with Healthy Blue, so many will switch plans in 2027.
Louisiana Healthcare Connections covers over 41% of about 44,600 members here, so Hammond clinics see its authorization rules often.
Ouachita holds around 48,600 Healthy Louisiana members, close to half of everyone enrolled in the Monroe area.
About 37,100 Healthy Louisiana members, nearly three times the count in nearby Avoyelles and the most around Alexandria.
AmeriHealth Caritas covers 21% of about 30,700 members in the Houma area, well above its roughly 15% statewide share.
The numbers below are Stream RCM company reported averages, not promised statewide results. Once we start, we’ll track these same numbers for your practice regularly, so you can compare them with your starting point.
Medical billing services in Louisiana cover everything from check-in to final payment: eligibility checks, coding, claim submission, payment posting, denial work, A/R follow-up and reporting for Medicare, Medicaid and private plans.
Stream RCM bills every Healthy Louisiana plan. From January 1, 2027, those plans are Aetna Better Health of Louisiana, AmeriHealth Caritas Louisiana, Humana Healthy Horizons in Louisiana and Louisiana Healthcare Connections. Fee-for-service Medicaid claims are covered too.
Visits through December 31, 2026, still get billed to Healthy Blue. For visits in 2027, look up the patient’s new plan first. Old prior auths only carry over for up to 60 days, so don’t wait to send new ones. LDH has the full details in Informational Bulletin 26-12.
Yes. Our team already works and trained in eClinicalWorks, AdvancedMD, Kareo, athenahealth, NextGen, DrChrono and many other systems.
Yes. Every provider who treats Medicaid patients must enroll in the Louisiana Medicaid Provider Enrollment Portal. We handle that, plus CAQH, PECOS, MCO credentialing and revalidation deadlines, which Louisiana does not extend.
From January 1, 2027, some expansion adults must work or do approved activities for 80 hours a month, or earn at least $580 a month, to keep Medicaid. Expect more coverage gaps in this group. See the LDH work requirements page for details.
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