1. A. The provider shall maintain all records necessary to demonstrate the services were provided in the quantity and quality claimed.

2. B. The provider bears the burden to prove its submitted claims were for services:

   1. 1. provided to a recipient in the quantity and quality claimed;
   2. 2. were medically necessary;
   3. 3. authorized by a qualified individual;
   4. 4. provided by an individual qualified to provide the service; and
   5. 5. in the case of a claim based on a cost report, prove each entry is complete, accurate, and supported by the necessary documentation.
3. C. Supporting documentation for services provided shall be accessible, legible, and comprehensible.
4. D. All records requiring signatures must be signed and dated at the time the services were provided.

5. E. Providers shall initial all rubber stamp signatures.

   1. 1. Paid claims not accompanied by timely signatures and/or documentation will be recovered. Late signatures without proper justification will not be accepted.
   2. 2. An error made in the record may be corrected by drawing a single line through the incorrect information. The word “error” shall be written by the strike-through, initialed, and dated. The original erroneous information shall remain visible and legible. Correction fluid or correction tape shall not be used to correct a record.
   3. 3. An explanation describing the necessity of the correction must accompany any corrected record. Supporting documentation for the correction shall be included with the explanation.
6. F. Records shall be maintained for the period required by law, regulation, and sub-regulatory guidance. Providers who fail to comply with the documentation standards are subject to any sanction allowed by this chapter.

7. G. Providers shall review their claims prior to submission to ensure:

   1. 1. the claims to be submitted are accurate;
   2. 2. they are supported by documentation showing the services were medically necessary;
   3. 3. they were provided by a person qualified to provide the service; and
   4. 4. they were provided in the quantity and quality being claimed.
8. H. Providers shall notify the department of any overpayment it discovers within 60 days of discovery. For the purposes of this subsection, identifying the final overpayment is not required if it is an unknown amount at the time of notification.

9. I. Providers shall repay any overpayment the department identifies within:

   1. 1. 60 days of a final overpayment decision; or
   2. 2. if the department has consented to a longer repayment schedule, according to the agreed upon payment schedule.

10. J. The provider must maintain and make available for inspection all documents required to demonstrate a claim is valid.

    1. 1. The documentation must be maintained for the period required by law, regulation, or sub-regulatory guidance.
    2. 2. Claims lacking supporting documentation the law, rule, or sub-regulatory guidance requires are not Medicaid reimbursable and shall be recovered.
    3. 3. Any sanction provided for in this Chapter may be imposed on a provider submitting claims for undocumented services.
11. K. Providers and recipients shall obey and follow all laws, rules, regulations, and sub-regulatory guidance.
12. L. Providers shall provide accurate contact information to receive correspondence. The provider shall inform BHSF, the fiscal intermediary, and the MCOs of any changes in its address prior to actual change of address.

13. M. Providers are presumed to know the applicable program’s laws, rules, and sub-regulatory guidance. Ignorance of the applicable laws, rules, or sub-regulatory guidance is not a defense to any administrative action. Knowledge of any amendments to the laws, rules, and sub-regulatory guidance will be presumed if:

    1. 1. notice of the changes was mailed to the address on the provider’s enrollment form;
    2. 2. the changes were posted to the department’s or the fiscal intermediary’s website, or
    3. 3. the changes were published in the State or Federal Register, the Louisiana Administrative Code, the Code of Federal Regulations, or State or Federal Statute.

14. N. Providers shall conduct all employee screening requirements that state or federal law, regulation, or sub-regulatory guidance requires. This includes:

    1. 1. criminal background searches,
    2. 2. federal and state exclusion searches, and
    3. 3. adverse action checks.

15. O. All employee screening shall be done in the frequency the law or regulation requires.

    1. 1. The background and exclusion searches shall include prospective and current employees.
    2. 2. The provider shall ensure criminal background and exclusion checks are performed on any non-employee performing any function or work for the provider.

16. P. If a provider discovers they have employed or otherwise affiliated with an excluded or disqualified person, the provider shall immediately terminate the relationship.

    1. 1. Within 10 business days of the discovery, the provider shall inform BHSF in writing of:

       1. a. the person’s identifying information;
       2. b. the date range of the prohibited affiliation;
       3. c. the claims that the provider submitted for services the person provided; and
       4. d. the amount paid for the claims attributable to the excluded or disqualified person.
17. Q. The provider shall inform BHSF in writing of all changes in ownership, control, or managing employee of the provider.

18. R. The provider shall inform BHSF of the following within 10 business days of discovery of:

    1. 1. any federal, state or territorial administrative sanctions imposed on the provider;
    2. 2. any criminal charges and convictions filed against the provider; and
    3. 3. any civil judgments, fines, or penalties entered against the provider.

19. S. When a license or certification is required, the provider shall be properly licensed, certified, or otherwise qualified to provide the services claimed.

    1. 1. The provider is responsible for ensuring any person working on the provider’s behalf possesses necessary licenses or qualifications.
    2. 2. Any claims submitted for services provided by a person lacking required credentials will be recovered.

20. T. The provider shall cooperate with any investigation or claims review the department or other health oversight agency institutes. When requested, the provider shall:

    1. 1. make all records requested available for review or copying. This includes the provider’s financial or other business records and/or any and all records related to the recipients;
    2. 2. make the providers, contractors, agents, employees, and other affiliates available for interviews. This may be done at the provider's ordinary place of business or any other mutually agreeable location;
    3. 3. allow the department or any other health oversight agency to take statements from the provider; and
    4. 4. allow the department or any other health oversight agency to take statements from any recipients the provider has claimed to have provided services.
21. U. The provider shall comply with all employment laws and regulations, including proper classification of employees and payment of all employer taxes or other assessments the law or regulations obligate an employer to pay.
22. V. The provider shall maintain all insurance policies the law or regulations require.
23. W. Services shall be provided in compliance with the law and a licensing or certification entity's regulations, rules, policies, or procedures governing the services provided.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and 46:437.1-46:440.3.

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Health, Bureau of Health Services Financing, LR 52:692 (May 2026).