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Medical Billing Services
in Lafayette, LA
Qualigenix handles the claim work for independent practices in Lafayette and the rest of Lafayette Parish through Qualigenix medical billing services. We bill every payer your patients carry, from Healthy Louisiana plans to Medicare and commercial insurers.
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How Qualigenix Serves Lafayette Practices
Qualigenix assigns each Lafayette practice one billing team that owns every claim from the visit to the deposit. The statewide rules, including Louisiana Medicaid's filing window, are covered on our medical billing services in Louisiana page. This page covers what's different for a practice in Lafayette Parish. Most Lafayette claims go to one of three payer groups: a Healthy Louisiana managed care plan, Medicare or a Medicare Advantage plan, or a commercial plan such as Blue Cross and Blue Shield of Louisiana. Each group has its own claim edits, portals and payment clocks. We work inside the EHR you already use, so your front desk keeps its routine and we take the claims from there. If you want eligibility, coding and A/R handled by one team, our full revenue cycle service covers all of it.
What Medical Billing Services Does Qualigenix Provide in Lafayette?
Qualigenix runs the full claim cycle for Lafayette practices: eligibility checks, charge review, claim scrubbing and submission, payment posting, denial appeals and follow-up on unpaid claims. We file to all five current Healthy Louisiana plans, Louisiana Medicaid fee-for-service, Medicare through Novitas Solutions, Medicare Advantage and commercial plans.
You pay a percentage of collections, so our fee depends on what your practice actually collects.
Billing for Lafayette Parish's Healthy Louisiana Plans
Healthy Louisiana plans cover the whole state, so every plan serves Lafayette Parish. In 2026, Lafayette practices have dealt with two plan exits in the same year, and that changes where claims go.
Five Plans, Then Four
Right now a Lafayette Medicaid patient can be on Aetna Better Health of Louisiana, AmeriHealth Caritas Louisiana, Healthy Blue, Humana Healthy Horizons in Louisiana or Louisiana Healthcare Connections. UnitedHealthcare's Healthy Louisiana contract ended earlier in 2026, and its members were moved to other plans. The Louisiana Department of Health has also ended its contract with Healthy Blue on December 31, 2026. From January 1, 2027, Healthy Blue members move to one of the four remaining plans. Qualigenix updates each patient's plan on file before the first 2027 claim goes out, so January visits aren't billed to a plan that no longer covers the patient.
Claims Sent by Plan
Each Healthy Louisiana plan runs its own claim edits, portal and remittance format. Louisiana Medicaid gives providers 365 days from the date of service to file an original claim, with a separate window for patients who get retroactive eligibility. Qualigenix doesn't wait on that window. We scrub each claim against the receiving plan's rules and send it within days of charge entry, then match the remittance back to the claim line by line.
Statewide Louisiana Billing Rules
Fee-for-service Medicaid claims, Medicaid filing limits and Louisiana's prompt-pay timelines work the same in Lafayette as anywhere else in the state. See how we handle each one on our Louisiana medical billing rules page.
Medicare and Commercial Payers for Lafayette Practices
Novitas Solutions processes Medicare Part A and Part B claims for Louisiana as the Jurisdiction H contractor, and CMS awarded Novitas a new Jurisdiction H contract in June 2026. Qualigenix builds Lafayette Medicare claims to Novitas edits and its local coverage policies. Lafayette Parish has about 21 dual-eligible special needs plans for 2026, from sponsors including Peoples Health, Humana, UnitedHealthcare, Aetna, Wellcare, Healthy Blue and Blue Cross and Blue Shield of Louisiana. For these patients we bill the Medicare plan first, then send the remaining balance to the patient's Healthy Louisiana plan. On commercial claims, Louisiana's updated prompt-pay rules start January 1, 2027. Insurers will have 10 days to pay, deny or pend a prior-authorized electronic clean claim and 25 days for other electronic clean claims. We follow up the day a claim passes its deadline.
PROVEN BILLING OUTCOMES
Results Lafayette Practices Can Expect
Qualigenix reports these numbers across all client practices. They're company-wide figures, not Lafayette-only results.
98%
Clean-claim rate on first submission
36 days
Average collection cycle
29-32%
Average cash-flow improvement across client practices
$50M+
A/R recovered for client practices
4.8%
Denial rate
79%
Denials overturned
PROVEN TRACK RECORDHIPAA-Compliant Revenue Cycle
275+ Clinics6-DAY ONBOARDING
How Onboarding Works
Qualigenix brings a Lafayette practice live in an average of 6 days, without changing your software.
01
Kickoff and System Access
We sign a BAA, set scope and get access to your EHR and clearinghouse. Your software stays the same.
02
Enrollment and Account Setup
We confirm your enrollment with each Healthy Louisiana plan, Novitas and your commercial payers, then set up your accounts.
03
Coders and Scrub Rules
A coder who knows your specialty is assigned, and plan-specific scrub rules are loaded for your payer mix.
04
EDI, ERA and EFT
Claim, remittance and payment routing are set up, and a test transaction confirms each one works.
05
Validation Batch Check
A first batch of claims is reviewed line by line before submission to catch setup errors early.
06
Go Live on Schedule
New claims start flowing, and our team works your existing A/R in parallel so older balances don't sit.
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WHY LAFAYETTE PRACTICES CHOOSE QUALIGENIX
Why Lafayette Practices Choose Qualigenix
Certified specialty coders, dedicated billers, native operation across 133 EHRs, monthly reports with defined metrics, and six-day average onboarding.
Specialty Coders, Dedicated Billers
Your claims go to certified coders who know your specialty and billers assigned to your account. You get the same people every month.
Works Inside Your EHR
Qualigenix works in 133 EMR/EHR platforms. Your staff keeps the system it knows, and we log in and bill from there.
Monthly Reports, Defined Metrics
Every month you get a report with clean-claim rate, denials, collections and A/R age, and every metric is defined so you can check it.
Six-Day Average Onboarding
Most practices go live in an average of 6 days, with no software change and old A/R worked alongside new claims.
LAFAYETTE BILLING FAQS
Frequently Asked Questions
Frequently asked questions regarding Healthy Louisiana plan changes, Novitas Medicare Jurisdiction H, D-SNP plans, and billing onboarding in Lafayette, LA.
Yes. Qualigenix bills Aetna Better Health of Louisiana, AmeriHealth Caritas Louisiana, Healthy Blue, Humana Healthy Horizons in Louisiana and Louisiana Healthcare Connections, plus Louisiana Medicaid fee-for-service. From January 1, 2027 we bill the four plans that remain after Healthy Blue's contract ends. Call 786-259-0231 to review your plan mix.
Healthy Blue's Medicaid contract ends December 31, 2026, and its members move to one of the four remaining Healthy Louisiana plans on January 1, 2027. Qualigenix confirms each patient's new plan before their first 2027 visit is billed and keeps 2026 Healthy Blue claims on a separate follow-up list.
Qualigenix bills traditional Medicare through Novitas Solutions, the Medicare contractor for Louisiana, and builds claims to Novitas edits and coverage policies. For dual-eligible patients, we bill the Medicare Advantage or special needs plan first, then the Healthy Louisiana plan for the remaining balance.
No. What matters is a team that knows Louisiana's payers: the Healthy Louisiana plans, Novitas and Blue Cross and Blue Shield of Louisiana. Qualigenix bills for practices in 48 states and works inside your existing EHR. Talk to a billing specialist to see how it would work for you.
Qualigenix bills all payers. That includes Healthy Louisiana plans, Louisiana Medicaid fee-for-service, Medicare, Medicare Advantage and dual-eligible plans, commercial insurers, and patient balances. If your patients carry it, we bill it.
Qualigenix charges a percentage of collections, so the fee tracks what your practice actually collects. The exact percentage depends on your specialty, claim volume and payer mix. Book a meeting and we'll quote it from your numbers.
Qualigenix brings practices live in an average of 6 days. We set up access, payer enrollment checks, scrub rules and payment routing, test a first batch, then go live while working your existing A/R so older claims don't stall during the switch.