As a PT practice provider, you focus on patient care and movement outcomes. However, when claim denials stack up, they quickly pull your attention from what matters most and put your revenue at risk.
Secondary claims are especially tricky because the rules vary by state, and one missed step can stall an entire batch. Here’s how we solved this exact problem for one of our clients.
The Problem: Unpaid Secondary Claims Piling Up
Our client, a multi-provider practice with patients enrolled in both Medicare Advantage plans and Louisiana Medicaid, came to us with a growing problem. Dozens of secondary claims to Louisiana Medicaid were unpaid. Some were being rejected outright, while others were sitting in limbo with no response.
The root cause was simple but frustrating.
Louisiana Medicaid does not provide a general provider portal for manual online submission of professional secondary claims. Unlike most states where you can log in, enter claim details, and submit electronically, Louisiana requires a specific process that catches many billing teams off guard.
After reviewing our client’s denied claims and researching the current Louisiana Medicaid submission guidelines, we identified three methods for getting secondary claims processed:
1. Electronic Secondary Claim Submission (837P)
If the primary payer is Traditional Medicare, claims typically crossover to Louisiana Medicaid automatically for secondary processing. However, when a crossover fails or additional information is requested, providers can submit electronic secondary claims using the 837P format through a clearinghouse. This method works for standard Medicare-to-Medicaid crossovers only.
2. Paper Claim Submission (CMS-1500)
This was the method our client needed for the majority of their stuck claims. When the primary payer is a commercial Medicare Advantage plan, such as Humana, Aetna, or UnitedHealthcare, the secondary claim to Louisiana Medicaid must be submitted on paper. There is no electronic workaround for these.
3. Medicare Crossover Claims (Automatic)
For patients with Traditional Medicare as primary, claims are generally forwarded automatically to Louisiana Medicaid for secondary processing. No additional paper claim is needed unless the crossover fails. Our client had a handful of failed crossovers that we resubmitted manually.
The Paper Submission Process for Louisiana Medicaid Secondary Claims
For the Medicare Advantage secondary claims, we assembled and submitted the following for each claim:
- The Medicare Advantage Professional Crossover Sheet (completed with all required fields)
- The original CMS-1500 claim form with specific modifications
- The primary payer’s Explanation of Benefits (EOB)
Carrier Codes
Louisiana Medicaid requires a specific carrier code in Box 9A of the CMS-1500 based on the primary Medicare Advantage payer. These are the codes we used:
| Primary Payer | Carrier Code |
|---|---|
| Humana | H19510 |
| Aetna | H57360 |
| UnitedHealthcare (UHC) | H39210 |
CMS-1500 Modifications
Before submitting each paper claim, we made the following updates to the CMS-1500 form:
- Box 9A: Entered the assigned carrier code based on the primary payer
- Box 17: Entered the referring provider’s name
- Box 17A: Entered the referring provider’s 7-digit Louisiana Medicaid Provider ID
- Box 17B: Entered the referring provider’s 10-digit NPI
- Box 23: Removed the primary payer authorization number
- Box 24J: Entered the rendering provider’s 7-digit Louisiana Medicaid Provider ID and 10-digit NPI
- Box 33A: Entered the rendering provider’s 10-digit NPI
- Box 33B: Entered the rendering provider’s 7-digit Louisiana Medicaid Provider ID
Crossover Sheet Details
Each submission also included a completed Medicare Advantage Professional Crossover Sheet with:
- Primary payer paid date
- Rendering provider’s 7-digit Louisiana Medicaid Provider ID
- Patient’s 13-digit Louisiana Medicaid ID number
- Primary allowed amount, deductible amount, and copayment/coinsurance amount
- Primary paid amount broken down by each CPT code
All documents were printed, assembled, and mailed to the Louisiana Medicaid fiscal intermediary for processing.
The Result
Within 60 days of submission, the previously unpaid secondary claims began processing, and payments were received. Our client recovered months of previously written-off secondary revenue. They were claiming that their in-house team gave up simply because the submission requirements were unclear.
The key takeaway: Louisiana Medicaid secondary claim submission is not difficult, but it is specific. Missing a carrier code, leaving the wrong authorization number in Box 23, or failing to include the crossover sheet will result in a rejection every time. There is no portal to fall back on, and no way to submit these claims electronically when the primary payer is a Medicare Advantage plan.
Let Park Medical Billing Handle Your Multi-Payer Claims
State-specific billing rules like Louisiana’s Medicaid secondary process are exactly the kind of operational detail that in-house billing teams miss. At Park Medical Billing, we manage multi-payer claim submission for practices across the country, including complex crossover scenarios, paper submissions, and payer-specific requirements.
Our team specializes in medical billing services and denial management for practices that are leaving revenue on the table due to unpaid secondary claims.
✓ 97–99% clean claim rate
✓ Dedicated account managers for every clinic
✓ No long-term contracts
Request a free consultation to find out how much revenue your practice is missing. Contact us today Or call (201) 585-7306.