Legal Compliance Monitoring

The Louisiana Department of Health (LDH) provides guidance for all contractors that produce denial and partial denial notices.  These notices are monitored to ensure compliance with the 42 Code of Federal Regulations (CFR) relative to timely and adequate notices of benefit determinations for prior authorized services.  This auditing and monitoring is being continued in the spirit of the previous litigation, better known as Wells vs. Gee.

Resources

As a result of the Joint stipulation from the Wells vs Gee settlement the LDH, in collaboration with the plaintiff’s council, developed multiple templates to help contractors, program offices, and Managed Care Organizations (MCO) maintain compliance with the CFR as it pertains to the development of denial and partial denial notices of prior authorized services. LDH strongly encourages continued use of these templates as a resource tool to assist with compliance.

DISCLAIMER:  The information contained in this website is provided for informational purposes only. It is the responsibility of each contractor to stay current on all applicable state and federal rules and regulations, policies and contract requirements.