Terms Used In Louisiana Revised Statutes > Title 46 > Chapter 3 > Part XIII > Subpart B - Provider Credentialing

• Adverse determination: means any of the following relative to a claim by a provider for payment for a healthcare service rendered by the provider to an enrollee of the Medicaid managed care organization:

              (a) A decision by a managed care organization that denies a claim in whole or in part. See Louisiana Revised Statutes 46:460.51

• Applicant: means a healthcare provider seeking to be approved or credentialed by a managed care organization to provide healthcare services to Medicaid enrollees. See Louisiana Revised Statutes 46:460.51
• Certificate of documentation: means a certificate issued by the United States Coast Guard for a vessel documented under 46 U. See Louisiana Revised Statutes 34:852.2
• Department: means the Department of Wildlife and Fisheries and its duly authorized representatives. See Louisiana Revised Statutes 34:852.2
• Department: means the Louisiana Department of Health. See Louisiana Revised Statutes 46:460.51
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Lienholder: means a person holding a security interest. See Louisiana Revised Statutes 34:852.2
• Manufacturer: means any person engaged in the business of manufacturing or importing new vessels or outboard motors for the purpose of sale or trade. See Louisiana Revised Statutes 34:852.2
• Outboard motor: means a mechanical combustion engine manufactured to produce a twenty-five or more horsepower engine and designed to attach outboard of the transom of a vessel. See Louisiana Revised Statutes 34:852.2
• Owner: means a person, other than a secured party, having property rights in, or title to, a vessel or outboard motor. See Louisiana Revised Statutes 34:852.2
• Person: means any natural person or individual, firm, partnership, corporation, association, limited liability company, or other entity. See Louisiana Revised Statutes 34:852.2
• provider: means a person, partnership, limited liability partnership, limited liability company, corporation, facility, or institution that provides healthcare or professional services to individuals enrolled in the Medicaid program. See Louisiana Revised Statutes 46:460.51
• Recipient: means the person who has received assistance under this Title. See Louisiana Revised Statutes 46:1
• Security interest: means an interest that is reserved or created by an agreement that secures payment or performance of an obligation. See Louisiana Revised Statutes 34:852.2
• services: means the services, items, supplies, or drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease. See Louisiana Revised Statutes 46:460.51
• Standardized information: means the customary universal data concerning an applicant's identity, education, and professional experience relative to a managed care organization's credentialing process including but not limited to name, address, telephone number, date of birth, social security number, educational background, state licensing board number, residency program, internship, specialty, subspecialty, fellowship, or certification by a regional or national healthcare or medical specialty college, association or society, prior and current place of employment, an adverse medical review panel opinion, a pending professional liability lawsuit, final disposition of a professional liability settlement or judgment, and information mandated by health insurance issuer accrediting organizations. See Louisiana Revised Statutes 46:460.51
• verification supporting statement: means the documentation confirming the information submitted by an applicant for a credentialing application from a specifically named entity or a regional, national, or general data depository providing primary source verification including but not limited to a college, university, medical school, teaching hospital, healthcare facility or institution, state licensing board, federal agency or department, professional liability insurer, or the National Practitioner Data Bank. See Louisiana Revised Statutes 46:460.51
• Vessel: means every description of watercraft and air boats, including homemade boats, other than a seaplane on the water, used or capable of being used as a means of transportation on water, valued in excess of two thousand five hundred dollars, to be principally operated on the waters of this state, required to be numbered, not held as inventory for sale or lease, and transferred for the first time on or after July 1, 2008. See Louisiana Revised Statutes 34:852.2