Managed Care Policies & Procedures - Archive (2019)

"Policy or procedure" shall mean a requirement governing the administration of managed care organizations specific to billing guidelines, medical management and utilization review guidelines, case management guidelines, claims processing guidelines and edits, grievance and appeals procedures and process, other guidelines or manuals containing pertinent information related to operations and pre-processing claims, and core benefits and services.

Below are items previously posted for public comment in 2019:

Item Number Policy/Procedure Date Posted Public Comments Due By Status Document Links
2019-LHCC-45 Court Ordered Services 12/27/19 2/10/20 Approved Court Ordered Services
2019-LHCC-48 EPSDT Personal Care Services 12/26/19 2/9/20 Approved EPSDT Personal Care Services
2019-UHC-200 Ablative Treatment for Spinal Pain (for Louisiana Only) 12/23/19 2/6/20 Completed Ablative Treatment for Spinal Pain (for Louisiana Only)
2019-UHC-201 Apheresis (for Louisiana Only) 12/23/19 2/6/20 Completed Apheresis (for Louisiana Only)
2019-UHC-202 Balloon Sinus Ostial Dilation (for Louisiana Only) 12/23/19 2/6/20 Completed Balloon Sinus Ostial Dilation (for Louisiana Only)
2019-UHC-203 Breast Reduction Surgery (for Louisiana Only) 12/23/19  2/6/20   Pending Breast Reduction Surgery (for Louisiana Only)
2019-UHC-204 Cardiac Event Monitoring 12/23/19 2/6/20 Completed Cardiac Event Monitoring
2019-UHC-205 Computed Tomographic Colonography 12/23/19 2/6/20 Completed Computed Tomographic Colonography
2019-UHC-206 Electric Tumor Treatment Field Therapy 12/23/19 2/6/20 Completed Electric Tumor Treatment Field Therapy
2019-UHC-207 Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation 12/23/19 2/6/20 Completed Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation
2019-UHC-208 Epidural Steroid and Facet Injections for Spinal Pain 12/23/19 2/6/20 Completed Epidural Steroid and Facet Injections for Spinal Pain
2019-UHC-210 Epiduroscopy, Epidural Lysis of Adhesions and Functional Anesthetic Discography (for Louisiana Only) 12/23/19 2/6/20 Completed Epiduroscopy, Epidural Lysis of Adhesions and Functional Anesthetic Discography (for Louisiana Only)
2019-UHC-211 Fecal Calprotectin Testing (for Louisiana Only) 12/23/19 2/6/20 Completed Fecal Calprotectin Testing (for Louisiana Only)
2019-UHC-212 Functional Endoscopic Sinus Surgery (FESS) (for Louisiana Only) 12/23/19 2/6/20 Completed Functional Endoscopic Sinus Surgery (FESS) (for Louisiana Only)
2019-UHC-213 Genetic Testing for Hereditary Cancer (for Louisiana Only) 12/23/19 2/6/20 Completed Genetic Testing for Hereditary Cancer (for Louisiana Only)
2019-UHC-214 Molecular Oncology Testing for Cancer Diagnosis, Prognosis, and Treatment Decisions (for Louisiana Only) 12/23/19 2/6/20 Completed Molecular Oncology Testing for Cancer Diagnosis, Prognosis, and Treatment Decisions (for Louisiana Only)
2019-UHC-215 Bone or Soft Tissue Healing and Fusion Enhancement Products 12/23/19 2/6/20 Completed Bone or Soft Tissue Healing and Fusion Enhancement Products
2019-UHC-216 DME 12/23/19 2/6/20 Completed DME
2019-UHC-217 Omnibus Codes 12/23/19 2/6/20 Completed Omnibus Codes
2019-UHC-218 Pharmacogenetic Testing 12/23/19 2/6/20 Completed Pharmacogenetic Testing
2019-UHC-219 Articular Defect Repairs 12/23/19 2/6/20 Completed Articular Defect Repairs
2019-UHC-220 Prolotherapy and Platelet Rich Plasma Therapies 12/23/19 2/6/20 Completed Prolotherapy and Platelet Rich Plasma Therapies
2019-UHC-221 Prosthetic Devices, Specialized, Microprocessor or Myoelectric Limbs 12/23/19 2/6/20 Completed Prosthetic Devices, Specialized, Microprocessor or Myoelectric Limbs
2019-UHC-222 Skin and Soft Tissue Substitutes (for Louisiana Only) 12/23/19 2/6/20 Completed Skin and Soft Tissue Substitutes (for Louisiana Only)
2019-UHC-223 Vagus and Trigeminal Nerve Stimulation 12/23/19 2/6/20 Completed Vagus and Trigeminal Nerve Stimulation
2019-UHC-224 Visual Information Processing Evaluation and Orthoptic and Vision Therapy 12/23/19 2/6/20 Completed Visual Information Processing Evaluation and Orthoptic and Vision Therapy
2019-UHC-247 Negative Pressure Wound Therapy 12/23/19 2/6/20 Completed Negative Pressure Wound Therapy
2019-LHCC-138 Appropriate UM Professionals 12/27/19 2/10/20 Approved Appropriate UM Professionals
2019-LHCC-139 UM Program Description 12/27/19 2/10/20 Approved UM Program Description
2019-ABH-118 Prior Authorization of PDHC 12/18/19 2/1/20 Approved Prior Authorization of PDHC
2019-ABH-117 Multi-Systemic Therapy 12/18/19 2/1/20 Approved Multi-Systemic Therapy
2019-ABH-116 Crisis Intervention Services 12/18/19 2/1/20 Approved Crisis Intervention Services
2019-HBL-128 Continuing Crisis Intervention Services 12/18/19 2/1/20 Approved Continuing Crisis Intervention Services
2019-UHC-125 Certification of Need for PRTFs 12/16/19 1/30/20 Approved Certification of Need for PRTFs
2019-PHARM-3 Mayzent 12/12/19 1/26/20 Approved Mayzent
2019-PHARM-4 Reclast 12/12/19 1/26/20 Approved Reclast
2019-PHARM-5 Vyndaquel Criteria 12/12/19 1/26/20 Approved Vyndaquel Criteria
2019-PHARM-6 Spinraza PA Form 12/12/19 1/26/20 Approved Spinraza PA Form
2019-PHARM-7 Rinvoq 12/12/19 1/26/20 Approved Rinvoq
2019-PHARM-8 Pamidronate Disodium 12/12/19 1/26/20 Approved Pamidronate Disodium
2019-PHARM-9 Neudexta 12/12/19 1/26/20 Approved Neudexta
2019-PHARM-10 Gattex 12/12/19 1/26/20 Approved Gattex
2019-PHARM-11 Epidiolex 12/12/19 1/26/20 Approved Epidiolex
2019-PHARM-12 Enzyme Replacement Therapy 12/12/19 1/26/20 Approved Enzyme Replacement Therapy
2019-PHARM-13 Cablivi Criteria 12/12/19 1/26/20 Approved Cablivi Criteria
2019-PHARM-14 Acthar Gel Criteria 12/12/19 1/26/20 Approved Acthar Gel Criteria
2019-PHARM-16 Nucala 12/12/19 1/26/20 Approved Nucala
2019-PHARM-17 POS Posting for November 2019 DUR 12/12/19 1/26/20 Approved POS Posting for November 2019 DUR
2019-ABH-122 Out of State Outpatient CCR 12/11/19 1/25/20 Approved Out of State Outpatient CCR
2019-UHC-123 Prior Authorization FAQ 2019 12/11/19 1/25/20 Approved Prior Authorization FAQ 2019
2019-LHCC-111 Functional Family Therapy – Child Welfare 12/11/19 1/25/20 Approved Functional Family Therapy – Child Welfare
2019-HBL-142 Med CAT II Changes Provider Letter 12/11/19 1/25/20 Approved Med CAT II Changes Provider Letter
2019-UHC-124 Intensive Outpatient Process Change Proposal 12/11/19 1/25/20 Approved Intensive Outpatient Process Change Proposal
2019-HBL-229 Special Health Care Needs Population 12/6/19 1/20/20 Approved Special Health Care Needs Population
2019-LHCC-134 ED Diversion PP 12/6/19 1/20/20 Approved ED Diversion PP
2019-LHCC-136 Oversight of Delegated UM 12/6/19 1/20/20 Approved Oversight of Delegated UM
2019-LHCC-137 UM Communication Services 12/6/19 1/20/20 Approved UM Communication Services
2019-LHCC-140 Timeliness of UM Decisions 12/6/19 1/20/20 Approved Timeliness of UM Decisions
2019-LHCC-141 Enteral and Oral Nutrition 12/6/19 1/20/20 Approved Enteral and Oral Nutrition
2019-HBL-228 Informal Reconsideration 12/5/19 1/19/20 Completed Informal Reconsideration
2019-HBL-240 Appeal Policy Provider Manual Updates 12/5/19 1/19/20 Approved Appeal Policy Provider Manual Updates
2019-LHCC-40 Provider policy revisions - Provider Orientation 12/5/19 1/19/20 Completed Provider policy revisions - Provider Orientation
2019-LHCC-41 Provider policy revisions - Provider Visit Schedule 12/5/19 1/19/20 Completed Provider policy revisions - Provider Visit Schedule
2019-LHCC-43 Quality Policy revisions - Appeals Process 12/5/19 1/19/20 Completed Quality Policy revisions - Appeals Process
2019-LHCC-47 Clinical policy revision requests - Authorization for Second Clinical Opinions 12/5/19 1/19/20 Completed Clinical policy revision requests - Authorization for Second Clinical Opinions
2019-LHCC-55 LHCC revisions to Operations policies - Call Line PP Provider Services Calls Hotline 12/5/19 1/19/20 Completed LHCC revisions to Operations policies - Call Line PP Provider Services Calls Hotline
2019-LHCC-105 Appeal of UM Decisions 12/5/19 1/19/20 Completed Appeal of UM Decisions
2019-LHCC-108 Womens Health Services 12/5/19 1/19/20 Completed Womens Health Services
2019-LHCC-109 Clinical Decision Criteria and Application 12/5/19 1/19/20 Completed Clinical Decision Criteria and Application InterQual Corporate Policy Variances
2019-LHCC-110 Continued Stay and Discharge Planning 12/5/19 1/19/20 Completed Continued Stay and Discharge Planning
2019-LHCC-133 Care Management Program Description 12/5/19 1/19/20 Approved Care Management Program Description
2019-UHC-225 Radiology CPT Codes 12/5/19 1/19/20 Approved Radiology CPT Codes
2019-UHC-238 Breast Reconstruction Not Following Mastectomy 12/5/19 1/19/20 Approved Breast Reconstruction Not Following Mastectomy
2019-UHC-239 Breast Reconstruction Post Mastectomy 12/5/19 1/19/20 Approved Breast Reconstruction Post Mastectomy
2019-HPA-4 Reimbursement of Opioid Use Disorder Treatment in Opioid Treatment Programs 11/26/19 1/10/20 Complete HPA: Reimbursement of Opioid Use Disorder Treatment in Opioid Treatment Programs
2019-Enbrel-1 Recommendation to Change Status of Enbrel of Medicaid PDL 11/25/19 1/9/20 Approved Recommendation to Change Status of Enbrel of Medicaid PDL
2019-HPA-3 Telemedicine/Telehealth Billing Changes for RHCs and FQHCs 11/25/19 1/10/20 Complete HPA: Telemedicine/Telehealth Billing Changes for RHCs and FQHCs
2019-IB-1 Telemedicine/Telehealth Billing Changes for RHCs and FQHCs 11/25/19 1/10/20 Complete IB: Telemedicine/Telehealth Billing Changes for RHCs and FQHCs 
2019-HPA-2 CLIA Number Information: Revised 11/15/19 12/30/19 Complete Revised HPA: CLIA Number Information
2019-Chisholm-1 Chisholm Compliance MCO User Process Manual 10/29/19 12/13/19 Complete Chisholm Compliance MCO User Process Manual
2019-Healthy Blue-95 MHR PSR Provider Bulletin 10/24/19 12/8/19 Approved MHR PSR Provider Bulletin
2019-LHCC-54 PCP Selection Change 10/14/19 11/28/19  Approved PCP Selection Change
2019-PHARM-2 MCO Criteria Changes 10/13/19 11/27/19  Complete MCO Criteria Changes
2019-LHCC-25 UM Communication Services 10/11/19 11/25/19  Approved UM Communication Services
2019-Healthy Blue-49 PA Req N Supervision for Hyperbaric O2 10/11/19 11/25/19  Approved PA Req N Supervision for Hyperbaric O2
2019-Healthy Blue-96 ICD-10 Coding Tips Sheet Flier 10/10/19 11/24/19  Approved ICD-10 Coding Tips Sheet Flier
2019-Healthy Blue-80 SBIRT Filter Update 10/10/19 11/24/19  Approved SBIRT Flier Update
2019 Healthy Blue-92 CCRT Configuration - PA Changes - Blue RFRF 10/10/19 11/24/19  Approved CCRT Configuration - PA Changes - Blue RFRF
2019-Healthy Blue-94 SUD Criteria for Prior Authorization 10/10/19 11/24/19  Approved SUD Criteria for Prior Authorization
2019-Healthy Blue-38 WAVE CG DME 46 Pneumatic 10/4/19 11/18/19  Approved WAVE CG DME 46 Pneumatic
2019-PHARM-1 Suspending Agents 9/25/19 11/9/19 Approved Suspending Agents
2019-PDL-1 Advair - PDL Changes 9/25/19 11/9/19 Pending PDL Changes
2019-UHC-29 Pharmacogenetic Testing 9/20/19 11/4/19 Approved Pharmacogenetic Testing
2019-UHC-27 UHC Prior Authorization LA Effective 9.1.19 9/13/19 10/28/19 Approved UHC Prior Authorization LA Effective 9.1.19
2019-HBL-20 Semi Annual Cost of Care Review 9/13/19 10/28/19 Approved BLA-NL-0148-19
2019-DUR-1 Pharmacy Drug Utilization Review (DUR) Criteria 9/13/19 10/28/19 Complete Pharmacy DUR Criteria effective 11/1 and 12/1
2019-IB-1 Proposed retirement of Informational Bulletin 16-1 9/12/19 10/27/19 Complete IB 16-1
2019-SCG-2  LDH stopped using self-reported data in 2018; the 416 reports are generated from MCO encounter data. 9/10/19 10/25/19 Complete MCO System Companion Guide, pg. 117
2019-SCG-1  Edit 472 disposition to be changed from "E" to "D" [deny]. 9/10/19 10/25/19 Complete  MCO System Companion Guide, pg. 128
2019-HPA-1 Severe Combined Immunodeficiency (SCID) 8/27/19 10/11/19 Complete Severe Combined Immunodeficiency (SCID)