Managed Care Policies & Procedures

COVID-19 Update: Changes to Medicaid policy and procedure deemed of an imminent peril to the public health, safety, or welfare and requiring immediate approval, such as those related to COVID-19, are exempt from the legislative requirement to publish the proposed policy or procedure for public comment prior to implementation. To keep abreast of these exempted changes to policy and procedure related to COVID-19, refer to the Coronavirus (COVID-19) Medicaid Information website, which provides guidance to Medicaid providers and managed care organizations, emergency rules, and requests LDH has submitted to the Centers for Medicare & Medicaid Services (CMS). Broader information related to COVID-19 can be found at http://ldh.la.gov/Coronavirus/.

In accordance with La. R.S. 46:460.51, et seq., prior to adopting, approving, amending, or implementing certain policies or procedures, LDH will publish the proposed policy or procedure for the purpose of soliciting public comments. For this purpose, a policy or procedure, as defined by the statute, 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.

The following table contains the LDH and managed care organization policies and procedures that are open for public comment. To provide feedback, please complete this form. Refer to the links below the table for archived postings and public comments.

To see the LDH and managed care organization Pharmacy and Medical Drug Policies, click here.

To see Dental Benefit Plan Manager Policies, click here.

Item Number Policy/Procedure Date Posted Comment Period Closed Status Document Links
2022-LHCC-129 Provider Directories 11/30/22 1/14/23 Pending

Provider Directories

2022-LHCC-900 Emergency Department Diversion 11/30/22 1/14/23 Pending

Emergency Department Diversion

2022-LHCC-1109 Diaphragmatic/Phrenic Nerve Stimulation 11/30/22 1/14/23 Pending

Diaphragmatic/Phrenic Nerve Stimulation

2022-LHCC-1111 Thyroid Insulin Test in Pediatrics 11/30/22 1/14/23 Pending

Thyroid Insulin Test in Pediatrics

2022-LHCC-1112 Digital EEG Analysis 11/30/22 1/14/23 Pending

Digital EEG Analysis

2022-LHCC-1113 Cardiac Biomarker Testing 11/30/22 1/14/23 Pending

Cardiac Biomarker Testing

2022-LHCC-1115 Vitamin D Testing in Pediatrics 11/30/22 1/14/23 Pending

Vitamin D Testing in Pediatrics

2022-LHCC-1211 Reduction Mammoplasty and Gynecomastia Surgery 11/30/22 1/14/23 Pending

Reduction Mammoplasty and Gynecomastia Surgery

2022-LHCC-1274 Osteogenic Stimulation 11/30/22 1/14/23 Pending

Osteogenic Stimulation

2022-LHCC-1278 Evoked Potential Testing 11/30/22 1/14/23 Pending

Evoked Potential Testing

2022-LHCC-1279 Measure Serum 1.25 Vit D 11/30/22 1/14/23 Pending

Measure Serum 1.25 Vit D

2022-LHCC-1280 EEG in the Evaluation of Headache 11/30/22 1/14/23 Pending

EEG in the Evaluation of Headache

2022-LHCC-1284 Preventive Health and Clinical Practice 11/30/22 1/14/23 Pending

Preventive Health and Clinical Practice

2022-LHCC-1361 Pediatric Heart Transplant 11/30/22 1/14/23 Pending

Pediatric Heart Transplant

2022-LHCC-1389 Endometrial Ablation 11/30/22 1/14/23 Pending

Endometrial Ablation

2022-ABH-1451 Crisis Stabilization Services for Adults 11/30/22 1/14/23 Pending

Crisis Stabilization Services for Adults

2022-LHCC-1470 Assertive Community Treatment 11/30/22 1/14/23 Pending

Assertive Community Treatment

2022-LHCC-1479 High Complexity Medical Decision-Making 11/30/22 1/14/23 Pending

High Complexity Medical Decision-Making

2022-LHCC-1701 Outpatient Testing for DOA (Drugs of Use) 11/30/22 1/14/23 Pending

Outpatient Testing for DOA (Drugs of Use)

2022-LHCC-1702 Holter Monitor 11/30/22 1/14/23 Pending

Holter Monitor

2022-LHCC-1703 Pediatric Kidney Transplant 11/30/22 1/14/23 Pending

Pediatric Kidney Transplant

2022-LHCC-1704 Helicobacter Pylori Serology Testing 11/30/22 1/14/23 Pending

Helicobacter Pylori Serology Testing

2022-LHCC-1705 Invasive and Non-Invasive Home Ventilator 11/30/22 1/14/23 Pending

Invasive and Non-Invasive Home Ventilator

2022-LHCC-1706 Wireless Motility Capsule 11/30/22 1/14/23 Pending

Wireless Motility Capsule

2022-HHH-1666 Speech Therapy Clinical Coverage Policy 11/28/22 1/12/23 Pending

Speech Therapy Clinical Coverage Policy

2022-HHH-1667 Ventilator Assist Devices Clinical Coverage policy 11/28/22 1/12/23 Pending

Ventilator Assist Devices Clinical Coverage policy

2022-HHH-1668 Wheelchair, Wheelchair repairs, Standing Frame, and Patient Lifts Clinical Coverage Policy 11/28/22 1/12/23 Pending

Wheelchair, Wheelchair repairs, Standing Frame, and Patient Lifts Clinical Coverage Policy

2022-HHH-1669 Wound Care Clinical Coverage policy 11/28/22 1/12/23 Pending

Wound Care Clinical Coverage policy

2022-HHH-1672 Delegation Compliance NMR and Focus Health 11/28/22 1/12/23 Pending

Delegation Compliance NMR and Focus Health

2022-HHH-1675 Focus Health Security Policy & Procedure 11/28/22 1/12/23 Pending

Focus Health Security Policy & Procedure

2022-HHH-1678 NMR Federal Exclusion Compliance Policy 11/28/22 1/12/23 Pending

NMR Federal Exclusion Compliance Policy

2022-HHH-1679 Permanent Supportive Housing (PSH) Services 11/28/22 1/12/23 Pending

Permanent Supportive Housing (PSH) Services

2022-HHH-1681 Health Record Review Strategy 11/28/22 1/12/23 Pending

Health Record Review Strategy

2022-HHH-1688 Drug Coverage Policy 11/28/22 1/12/23 Pending

Drug Coverage Policy

2022-HHH-1689 Pre Del- Results 11/28/22 1/12/23 Pending

Pre Del- Results

2022-HHH-1690 Board Certified Staff Listing 11/28/22 1/12/23 Pending

Board Certified Staff Listing

2022-HHH-1691 Delegation Compliance Audit Summary Report 11/28/22 1/12/23 Pending

Delegation Compliance Audit Summary Report

2022-HHH-1692 UM-2 Staffing NDT Additions 11/28/22 1/12/23 Pending

UM-2 Staffing NDT Additions

2022-HHH-1693 UM-05 UM Org Chart 11/28/22 1/12/23 Pending

UM-05 UM Org Chart

2022-HHH-1694 Eligibility and Verification 11/28/22 1/12/23 Pending

Eligibility and Verification

2022-HHH-1695 Redacted 11/28/22 1/12/23 Pending

Redacted

2022-HHH-1696 Focus Health Financial Incentive Policy 11/28/22 1/12/23 Pending

Focus Health Financial Incentive Policy

2022-HHH-1697 NMR Appropriate Professionals 11/28/22 1/12/23 Pending

NMR Appropriate Professionals

2022-HHH-1698 Delegation Compliance NCH Management-Evolent 11/28/22 1/12/23 Pending

Delegation Compliance NCH Management-Evolent

2022-HHH-1699 Health Record Review Tool 11/28/22 1/12/23 Pending

Health Record Review Tool

2022-HHH-1644 Blepharoplasty, Blepharoptosis Repair and Brow Lift Clinical Coverage 11/28/22 1/12/23 Pending

Blepharoplasty, Blepharoptosis Repair and Brow Lift Clinical Coverage

2022-HHH-1645 Breast Surgery Clinical Coverage Policy 11/28/22 1/12/23 Pending

Breast Surgery Clinical Coverage Policy

2022-HHH-1646 Cochlear Implant Clinical Coverage Policy 11/28/22 1/12/23 Pending

Cochlear Implant Clinical Coverage Policy

2022-HHH-1647 Continuous Subcutaneous Insulin External Infusion Pump Clinical Coverage Policy 11/28/22 1/12/23 Pending

Continuous Subcutaneous Insulin External Infusion Pump Clinical Coverage Policy

2022-HHH-1649 Delegation Compliance UM.15 NCH 11/28/22 1/12/23 Pending

Delegation Compliance UM.15 NCH

2022-HHH-1650 Delegation Compliance UM.15 NMR 11/28/22 1/12/23 Pending

Delegation Compliance UM.15 NMR

2022-HHH-1651 Gender Affirmation Surgery Clinical Coverage Policy 11/28/22 1/12/23 Pending

Gender Affirmation Surgery Clinical Coverage Policy

2022-HHH-1652 Genetic Testing for Breast and Ovarian Cancer, FAP, and Lynch Syndrome Clinical Coverage Policy 11/28/22 1/12/23 Pending

Genetic Testing for Breast and Ovarian Cancer, FAP, and Lynch Syndrome Clinical Coverage Policy

2022-HHH-1653 Hearing Aids Clinical Policy 11/28/22 1/12/23 Pending

Hearing Aids Clinical Policy

2022-HHH-1654 High Frequency Chest Wall Oscillation Devices Clinical Coverage Policy 11/28/22 1/12/23 Pending

High Frequency Chest Wall Oscillation Devices Clinical Coverage Policy

2022-HHH-1655 Home Health Clinical Coverage Policy 11/28/22 1/12/23 Pending

Home Health Clinical Coverage Policy

2022-HHH-1656 Hospice Clinical Coverage Policy 11/28/22 1/12/23 Pending

Hospice Clinical Coverage Policy

2022-HHH-1657 Hospital Bed Clinical Coverage Policy 11/28/22 1/12/23 Pending

Hospital Bed Clinical Coverage Policy

2022-HHH-1659 Inhaled Nitric Oxide Clinical Coverage Policy 11/28/22 1/12/23 Pending

Inhaled Nitric Oxide Clinical Coverage Policy

2022-HHH-1660 Intrathecal Baclofen Therapy Clinical Coverage Policy 11/28/22 1/12/23 Pending

Intrathecal Baclofen Therapy Clinical Coverage Policy

2022-HHH-1661 Molecular Diagnostic Assays and Breath Testing for Transplant Rejection Clinical Coverage Policy 11/28/22 1/12/23 Pending

Molecular Diagnostic Assays and Breath Testing for Transplant Rejection Clinical Coverage Policy

2022-HHH-1662 Osteogenic Bone Growth Stimulators 11/28/22 1/12/23 Pending

Osteogenic Bone Growth Stimulators

2022-HHH-1663 Personal Care Services (PCS) Clinical Coverage Policy 11/28/22 1/12/23 Pending

Personal Care Services (PCS) Clinical Coverage Policy

2022-HHH-1664 Pediatric Day Health Care Clinical Coverage Policy 11/28/22 1/12/23 Pending

Pediatric Day Health Care Clinical Coverage Policy

2022-HHH-1665 Physical and Occupational Therapy Clinical Coverage Policy 11/28/22 1/12/23 Pending

Physical and Occupational Therapy Clinical Coverage Policy

2022-HHH-1621 Timeliness of UM Determinations and Notifications UM8 11/28/22 1/12/23 Pending

Timeliness of UM Determinations and Notifications UM8

2022-HHH-1622 Continuity of Care and Care Transitions UM8 11/28/22 1/12/23 Pending

Continuity of Care and Care Transitions UM8

2022-HHH-1623 Medical Necessity Appropriateness Case Processing UM8 11/28/22 1/12/23 Pending

Medical Necessity Appropriateness Case Processing UM8

2022-HHH-1624 Fraud, Waste, and Abuse Policy UM8 11/28/22 1/12/23 Pending

Fraud, Waste, and Abuse Policy UM8

2022-HHH-1625 Confidentiality Policy UM8 11/28/22 1/12/23 Pending

Confidentiality Policy UM8

2022-HHH-1626 Inter Rater Reliability Assessment - Clinical Staff 11/28/22 1/12/23 Pending

Inter Rater Reliability Assessment - Clinical Staff

2022-HHH-1627 Standard Pre-Service Request for Authorization 11/28/22 1/12/23 Pending

Standard Pre-Service Request for Authorization

2022-HHHH-1628 Utilization Management Criteria Development 11/28/22 1/12/23 Pending

Utilization Management Criteria Development

2022-HHH-1629 Over and Under Utilization 11/28/22 1/12/23 Pending

Over and Under Utilization

2022-HHH-1630 Retrospective Utilization Review 11/28/22 1/12/23 Pending

Retrospective Utilization Review

2022-HHH-1631 Guidelines for Initial Screening 11/28/22 1/12/23 Pending

Guidelines for Initial Screening

2022-HHH-1632 Inter Rater Reliability Assessment - Non-Clinical Staff 11/28/22 1/12/23 Pending

Inter Rater Reliability Assessment - Non-Clinical Staff

2022-HHH-1633 Medical Necessity Determination Process 11/28/22 1/12/23 Pending

Medical Necessity Determination Process

2022-HHH-1634 Timeframes for Completing the Independent Review Process 11/28/22 1/12/23 Pending

Timeframes for Completing the Independent Review Process

2022-HHH-1635 Timeliness of UM Decisions for Delegated UM Cases 11/28/22 1/12/23 Pending

Timeliness of UM Decisions for Delegated UM Cases

2022-HHH-1636 Utilization Management Clinical Practice Guidelines 11/28/22 1/12/23 Pending

Utilization Management Clinical Practice Guidelines

2022-HHH-1639 New Hire MAP 11/28/22 1/12/23 Pending

New Hire MAP

2022-HHH-1640 Delegation Compliance UM13 11/28/22 1/12/23 Pending

Delegation Compliance UM13

2022-HHH-1642 ABA Clinical Coverage 11/28/22 1/12/23 Pending

ABA Clinical Coverage

2022-HHH-1643 Bariatric Surgery Clinical Coverage Policy 11/28/22 1/12/23 Pending

Bariatric Surgery Clinical Coverage Policy

2022-HHH-1427 Medication Preauthorization and Notification List 11/28/22 1/12/23 Pending

Medication Preauthorization and Notification List

2022-HHH-1591 Enrollee Satisfaction Surveys 11/28/22 1/12/23 Pending

Enrollee Satisfaction Surveys

2022-HHH-1592 Health Record Review Strategy 11/28/22 1/12/23 Pending

Health Record Review Strategy

2022-HHH-1593 Provider Manual 11/28/22 1/12/23 Pending

Provider Manual

2022-HHH-1594 Continuity of Care Claims Process and Guidelines 11/28/22 1/12/23 Pending

Continuity of Care Claims Process and Guidelines

2022-HHH-1595 Permanent Supportive Housing Job Description 11/28/22 1/12/23 Pending

Permanent Supportive Housing Job Description

2022-HHH-1597 Delegation Compliance Focus Health UM 2 11/28/22 1/12/23 Pending

Delegation Compliance Focus Health UM 2

2022-HHH-1598 Delegation Compliance Network Medical Review UM 2 11/28/22 1/12/23 Pending

Delegation Compliance Network Medical Review UM 2

2022-HHH-1599 New Century Health Utilization Management Plan UM 2 11/28/22 1/12/23 Pending

New Century Health Utilization Management Plan UM 2

2022-HHH-1601 Delegation Compliance Network Medical Review UM 3 11/28/22 1/12/23 Pending

Delegation Compliance Network Medical Review UM 3

2022-HHH-1605 Delegation Compliance Network Medical Review UM 4 11/28/22 1/12/23 Pending

Delegation Compliance Network Medical Review UM 4

2022-HHH-1606 Louisiana UM Program Description 11/28/22 1/12/23 Pending

Louisiana UM Program Description

2022-HHH-1610 UM Org Chart 11/28/22 1/12/23 Pending

UM Org Chart

2022-HHH-1611 Clinical Criteria for Delegated UM Decisions 11/28/22 1/12/23 Pending

Clinical Criteria for Delegated UM Decisions

2022-HHH-1613 UM8 Confidentiality of PHI 11/28/22 1/12/23 Pending

UM8 Confidentiality of PHI

2022-HHH-1614 UM8 Decision Notice 11/28/22 1/12/23 Pending

UM8 Decision Notice

2022-HHH-1615 UM8 Denial Notices in Delegated UM Cases 11/28/22 1/12/23 Pending

UM8 Denial Notices in Delegated UM Cases

2022-HHH-1617 Abortion, Hysterectomy and Sterilization UM8 11/28/22 1/12/23 Pending

Abortion, Hysterectomy and Sterilization UM8

2022-HHH-1618 Non-Emergency Ambulance Transportation UM8 11/28/22 1/12/23 Pending

Non-Emergency Ambulance Transportation UM8

2022-HHH-1619 Permanent Supportive Housing (PSH) Services UM8 11/28/22 1/12/23 Pending

Permanent Supportive Housing (PSH) Services UM8

2022-UHC-478 Obstructive and Central Sleep Apnea Treatment 11/18/22 1/2/23 Pending

Obstructive and Central Sleep Apnea Treatment

2022-UHC-490 Cardiovascular Disease Risk Tests 11/18/22 1/2/23 Pending

Cardiovascular Disease Risk Tests

2022-HBL-1023 Genetic Testing for Inherited Diseases 11/18/22 1/2/23 Pending

Genetic Testing for Inherited Diseases

2022-UHC-1589 Surgical Treatment of Lymphedema 11/18/22 1/2/23 Pending

Surgical Treatment of Lymphedema

2022-LHCC-1504 Reporting the Global Maternity Package 11/18/22 1/2/23 Pending

Reporting the Global Maternity Package

2022-LHCC-1505 Moderate Conscious Sedation 11/18/22 1/2/23 Pending

Moderate Conscious Sedation

2022-LHCC-1506 Never Paid Events 11/18/22 1/2/23 Pending

Never Paid Events

2022-LHCC-1507 Clinical Validation of Modifier 59 11/18/22 1/2/23 Pending

Clinical Validation of Modifier 59

2022-LHCC-1508 Intravenous Hydration 11/18/22 1/2/23 Pending

Intravenous Hydration

2022-LHCC-1509 Clinical Validation of Modifier 25 11/18/22 1/2/23 Pending

Clinical Validation of Modifier 25

2022-LHCC-1510 EM Bundling with Labs and Radiology 11/18/22 1/2/23 Pending

EM Bundling with Labs and Radiology

2022-LHCC-1511 Unlisted Procedure Codes 11/18/22 1/2/23 Pending

Unlisted Procedure Codes

2022-LHCC-1512 Maximum Units of Service 11/18/22 1/2/23 Pending

Maximum Units of Service

2022-LHCC-1514 Technology Supported Authorization Screening 11/18/22 1/2/23 Pending

Technology Supported Authorization Screening

2022-LHCC-1515 Temporary Limited Authorization Reviews 11/18/22 1/2/23 Pending

Temporary Limited Authorization Reviews

2022-LHCC-1524 Posterior Tibial Nerve Stimulation for Voiding Dysfunction 11/18/22 1/2/23 Pending

Posterior Tibial Nerve Stimulation for Voiding Dysfunction

2022-LHCC-1525 Intradiscal Steroid Injections for Pain Management 11/18/22 1/2/23 Pending

Intradiscal Steroid Injections for Pain Management

2022-LHCC-1526 Trigger Point Injections 11/18/22 1/2/23 Pending

Trigger Point Injections

2022-LHCC-1527 Nerve Blocks and Neurolysis for Pain Management 11/18/22 1/2/23 Pending

Nerve Blocks and Neurolysis for Pain Management

2022-ABH-1529 Abortion Procedures 11/18/22 1/2/23 Pending

Abortion Procedures

2022-LHCC-1483 Inpatient Consultation 11/18/22 1/2/23 Pending

Inpatient Consultation

2022-LHCC-1484 Status B Bundled Services 11/18/22 1/2/23 Pending

Status B Bundled Services

2022-LHCC-1485 Unbundled Surgical Procedures 11/18/22 1/2/23 Pending

Unbundled Surgical Procedures

2022-LHCC-1486 Post-operative Visits 11/18/22 1/2/23 Pending

Post-operative Visits

2022-LHCC-1488 Unbundled Professional Services 11/18/22 1/2/23 Pending

Unbundled Professional Services

2022-LHCC-1489 Multiple CPT Code Replacement 11/18/22 1/2/23 Pending

Multiple CPT Code Replacement

2022-LHCC-1490 Transgender Related Services 11/18/22 1/2/23 Pending

Transgender Related Services

2022-LHCC-1491 NCCI Unbunding 11/18/22 1/2/23 Pending

NCCI Unbunding

2022-LHCC-1492 New Patient 11/18/22 1/2/23 Pending

New Patient

2022-LHCC-1493 Supplied billed on Same day as Surgery 11/18/22 1/2/23 Pending

Supplied billed on Same day as Surgery

2022-LHCC-1494 Assistant Surgeon 11/18/22 1/2/23 Pending

Assistant Surgeon

2022-LHCC-1495 Add-on Code Billed without Primary Code 11/18/22 1/2/23 Pending

Add-on Code Billed without Primary Code

2022-LHCC-1496 Hospital Visit Codes Billed with Labs 11/18/22 1/2/23 Pending

Hospital Visit Codes Billed with Labs

2022-LHCC-1497 Modifier to Procedure Code Validation 11/18/22 1/2/23 Pending

Modifier to Procedure Code Validation

2022-LHCC-1498 Professional Component Modifier 11/18/22 1/2/23 Pending

Professional Component Modifier

2022-LHCC-1499 Clean Claims Policy 11/18/22 1/2/23 Pending

Clean Claims Policy

2022-LHCC-1500 Pulse Oximetry with Office Visits 11/18/22 1/2/23 Pending

Pulse Oximetry with Office Visits

2022-LHCC-1501 Distinct Procedural Modifiers 11/18/22 1/2/23 Pending

Distinct Procedural Modifiers

2022-LHCC-1502 Professional Services Billed with Labs 11/18/22 1/2/23 Pending

Professional Services Billed with Labs

2022-LHCC-1503 Inpatient Only Procedures 11/18/22 1/2/23 Pending

Inpatient Only Procedures

2022-LHCC-315 Testing Select GU Conditions 11/18/22 1/2/23 Pending

Testing Select GU Conditions

2022-UHC-476 Cytological Examination of Breast Fluids for Cancer Screening or Diagnosis 11/18/22 1/2/23 Pending

Cytological Examination of Breast Fluids for Cancer Screening or Diagnosis

2022-UHC-578 Thermography 11/18/22 1/2/23 Pending

Thermography

2022-LHCC-900 Emergency Department Diversion 11/18/22 1/2/23 Withdrawn

Emergency Department Diversion

2022-ACLA-944 Assertive Community Treatment 11/18/22 1/2/23 Pending

Assertive Community Treatment

2022-LHCC-991 Concurrent Review 11/18/22 1/2/23 Pending

Concurrent Review

2022-LHCC-1228 Sacroiliac Joint Interventions for Pain Management 11/18/22 1/2/23 Pending

Sacroiliac Joint Interventions for Pain Management

2022-LHCC-1265 Vagus Nerve Stimulation 11/18/22 1/2/23 Pending

Vagus Nerve Stimulation

2022-LHCC-1388 Code Edting Overview 11/18/22 1/2/23 Pending

Code Edting Overview

2022-HBL-1409 Mods 25 and 57: Eval and Mgmt with Global Procedure 11/18/22 1/2/23 Pending

Mods 25 and 57: Eval and Mgmt with Global Procedure

2022-LHCC-1415 Pulmonary Function Testing 11/18/22 1/2/23 Pending

Pulmonary Function Testing

2022-LHCC-1472 Transparency Policy: Place of Service Mismatch 11/18/22 1/2/23 Pending

Transparency Policy: Place of Service Mismatch

2022-LHCC-1474 Not medically Necessary Inpatient Professional Services 11/18/22 1/2/23 Pending

Not medically Necessary Inpatient Professional Services

2022-LHCC-1475 Urine Specimen Validity Testing 11/18/22 1/2/23 Pending

Urine Specimen Validity Testing

2022-LHCC-1476 Status P Bundled Services 11/18/22 1/2/23 Pending

Status P Bundled Services

2022-LHCC-1477 Duplicate Primary Code Billing 11/18/22 1/2/23 Pending

Duplicate Primary Code Billing

2022-LHCC-1478 Visits on Same Day as Surgery 11/18/22 1/2/23 Pending

Visits on Same Day as Surgery

2022-LHCC-1480 Pre-operative Visits 11/18/22 1/2/23 Pending

Pre-operative Visits

2022-LHCC-1481 Outpatient Consultation 11/18/22 1/2/23 Pending

Outpatient Consultation

2022-LHCC-1482 Modifier Date of Service Validation 11/18/22 1/2/23 Pending

Modifier Date of Service Validation

2022-HHH-1570-NEW Covered Benefits and Services 11/17/22 1/1/23 Pending

Covered Benefits and Services

2022-HHH-1571-NEW Non-Emergency Ambulance Transportation 11/17/22 1/1/23 Pending

Non-Emergency Ambulance Transportation

2022-HHH-1572-NEW Permanent Supportive Housing 11/17/22 1/1/23 Pending

Permanent Supportive Housing

2022-HHH-1573-NEW Psychiatric Residential Treatment Facility (PRTF) 11/17/22 1/1/23 Pending

Psychiatric Residential Treatment Facility (PRTF)

2022-HHH-1574-NEW Timeliness of UM Determinations and Notifications 11/17/22 1/1/23 Pending

Timeliness of UM Determinations and Notifications

2022-HHH-1575-NEW Access and Attitude Complaints 11/17/22 1/1/23 Pending

Access and Attitude Complaints

2022-HHH-1576-NEW Observation Level of Care 11/17/22 1/1/23 Pending

Observation Level of Care

2022-HHH-1577-NEW Patient Safety Retrospective Drug Utilization Review (DUR) 11/17/22 1/1/23 Denied

Patient Safety Retrospective Drug Utilization Review (DUR)

2022-HHH-1578-NEW PCP Attribution Dispute Process 11/17/22 1/1/23 Pending

PCP Attribution Dispute Process

2022-HHH-1579-NEW Peer Support Services 11/17/22 1/1/23 Pending

Peer Support Services

2022-HHH-1580-NEW Personal Care Services (PCS) for Adults with Serious Mental Illness (SMI) 11/17/22 1/1/23 Pending

Personal Care Services (PCS) for Adults with Serious Mental Illness (SMI)

2022-HHH-1581-NEW Utilization Management Inter-Rate Reliability 11/17/22 1/1/23 Pending

Utilization Management Inter-Rate Reliability

2022-HHH-1582-NEW Psychiatric Residential Treatment Facilities 11/17/22 1/1/23 Pending

Psychiatric Residential Treatment Facilities

2022-HHH-1583-NEW Review for Readmission Workflow 11/17/22 1/1/23 Pending

Review for Readmission Workflow

2022-HHH-1584-NEW Therapeutic Group Therapy 11/17/22 1/1/23 Pending

Therapeutic Group Therapy

2022-HHH-1585-NEW Timely Access to Care Mystery Shopper Process 11/17/22 1/1/23 Pending

Timely Access to Care Mystery Shopper Process

2022-HHH-1586-NEW Justice Enollees Enrollment Process 11/17/22 1/1/23 Pending

Justice Enollees Enrollment Process

2022-HHH-1550-NEW Special Population: AJ vs LDH Liaison Process 11/17/22 1/1/23 Pending

Special Population: AJ vs LDH Liaison Process

2022-HHH-1551-NEW Chisolm CM Prior Authorization Liaison (PAL) Review 11/17/22 1/1/23 Pending

Chisolm CM Prior Authorization Liaison (PAL) Review

2022-HHH-1552-NEW Coordinated Systems of Care (CSoC) Care Management Process 11/17/22 1/1/23 Pending

Coordinated Systems of Care (CSoC) Care Management Process

2022-HHH-1553-NEW DOC Pre-Release Program Process 11/17/22 1/1/23 Pending

DOC Pre-Release Program Process

2022-HHH-1554-NEW Continuity of Care and Care Transitions 11/17/22 1/1/23 Pending

Continuity of Care and Care Transitions

2022-HHH-1555-NEW Review for Readmission 11/17/22 1/1/23 Pending

Review for Readmission

2022-HHH-1556-NEW Care Management Program Description 11/17/22 1/1/23 Pending

Care Management Program Description

2022-HHH-1557-NEW Chisholm Policy 11/17/22 1/1/23 Pending

Chisholm Policy

2022-HHH-1558-NEW LA MCD Justice Involved Enrollment Process 11/17/22 1/1/23 Pending

LA MCD Justice Involved Enrollment Process

2022-HHH-1559-NEW Medicaid Encounter Submission - Pharmacy Encounters 11/17/22 1/1/23 Pending

Medicaid Encounter Submission - Pharmacy Encounters

2022-HHH-1560-NEW Pharmacy Coverage Policy 11/17/22 1/1/23 Pending

Pharmacy Coverage Policy

2022-HHH-1561-NEW Multi-Systemic Therapy (MST) 11/17/22 1/1/23 Pending

Multi-Systemic Therapy (MST)

2022-HHH-1562-NEW Overview of Provider Contracting 11/17/22 1/1/23 Pending

Overview of Provider Contracting

2022-HHH-1563-NEW Complaints on Practitioner Office and Facility Sites 11/17/22 1/1/23 Pending

Complaints on Practitioner Office and Facility Sites

2022-HHH-1564-NEW Abortion, Hysterectomy and Sterilization 11/17/22 1/1/23 Pending

Abortion, Hysterectomy and Sterilization

2022-HHH-1565-NEW Chisolm Prior Authorization Liaison (PAL) process 11/17/22 1/1/23 Pending

Chisolm Prior Authorization Liaison (PAL) process

2022-HHH-1566-NEW Louisiana MTM Medicaid Program 11/17/22 1/1/23 Pending

Louisiana MTM Medicaid Program

2022-HHH-1567-NEW LA Medicaid PCP Auto Assignment Process 11/17/22 1/1/23 Pending

LA Medicaid PCP Auto Assignment Process

2022-HHH-1568-NEW CNO On-Going Licensure Monitoring Process 11/17/22 1/1/23 Pending

CNO On-Going Licensure Monitoring Process

2022-HHH-1569-NEW MD Review of Authorizations 11/17/22 1/1/23 Pending

MD Review of Authorizations

2022-HHH-1530-NEW 300-NCCI MCO Cost Savings 11/17/22 1/1/23 Pending

300-NCCI MCO Cost Savings

2022-HHH-1531-NEW ABA Clinical Coverage 11/17/22 1/1/23 Pending

ABA Clinical Coverage

2022-HHH-1532-NEW Assertive Community Treatment (ACT/FACT) 11/17/22 1/1/23 Pending

Assertive Community Treatment (ACT/FACT)

2022-HHH-1533-NEW Staff Credentials Verification 11/17/22 1/1/23 Pending

Staff Credentials Verification

2022-HHH-1534-NEW COC Process Map 11/17/22 1/1/23 Pending

COC Process Map

2022-HHH-1535-NEW Community Brief Crisis Support (CBCS) 11/17/22 1/1/23 Pending

Community Brief Crisis Support (CBCS)

2022-HHH-1536-NEW Continuation of Care - Pharmacy Coverage Policy 11/17/22 1/1/23 Withdrawn

Continuation of Care - Pharmacy Coverage Policy

2022-HHH-1537-NEW Mental Health Rehabilitation Services - Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR) 11/17/22 1/1/23 Pending

Mental Health Rehabilitation Services - Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR)

2022-HHH-1538-NEW Credentialed Providers/Credentialing Current Monthly Sanction Tracking 11/17/22 1/1/23 Pending

Credentialed Providers/Credentialing Current Monthly Sanction Tracking

2022-HHH-1539-NEW Crisis Intervention - Follow Up 11/17/22 1/1/23 Pending

Crisis Intervention - Follow Up

2022-HHH-1540-NEW Crisis Stabilization Services for Adults 11/17/22 1/1/23 Pending

Crisis Stabilization Services for Adults

2022-HHH-1541-NEW Crisis Stabilization for Children and Adolescents 11/17/22 1/1/23 Pending

Crisis Stabilization for Children and Adolescents

2022-HHH-1542-NEW Department of Justice (DOJ) Community Case Management Program and PASRR Level II Evaluations 11/17/22 1/1/23 Pending

Department of Justice (DOJ) Community Case Management Program and PASRR Level II Evaluations

2022-HHH-1543-NEW EPSDT Personal Care Services (PCS) 11/17/22 1/1/23 Pending

EPSDT Personal Care Services (PCS)

2022-HHH-1544-NEW HCPR & MIT Medicaid Coverage Determination Policy 11/17/22 1/1/23 Pending

HCPR & MIT Medicaid Coverage Determination Policy

2022-HHH-1545-NEW Humana Healthy Horizons in Louisiana Lock-In Program 11/17/22 1/1/23 Pending

Humana Healthy Horizons in Louisiana Lock-In Program

2022-HHH-1546-NEW Utilization Management Committee Charter 11/17/22 1/1/23 Pending

Utilization Management Committee Charter

2022-HHH-1547-NEW Primary Care Physician Designation/Attribution Management 11/17/22 1/1/23 Pending

Primary Care Physician Designation/Attribution Management

2022-HHH-1548-NEW Individual Placement and Support (IPS) 11/17/22 1/1/23 Pending

Individual Placement and Support (IPS)

2022-HHH-1549-NEW Chisolm UM SME Process 11/17/22 1/1/23 Pending

Chisolm UM SME Process

2022-LDH-15 MCO Manual 3.0 (Proposed effective date = 1/1/2023) 11/15/22 12/30/22 Pending

MCO Manual 3.0 (Proposed effective date = 1/1/2023)

2022-UHC-201 Apheresis 11/2/22 12/17/22 Pending

Apheresis

2022-UHC-378 Surgery of the Shoulder 11/2/22 12/17/22 Pending

Surgery of the Shoulder

2022-ABH-496 Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR) Services 11/2/22 12/17/22 Pending

Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR) Services

2022-UHC-558 Surgery of the Knee 11/2/22 12/17/22 Pending

Surgery of the Knee

2022-UHC-579 Surgery of the Hip 11/2/22 12/17/22 Pending

Surgery of the Hip

2022-UHC-780 Core Decompression Avascular Necrosis 11/2/22 12/17/22 Pending

Core Decompression Avascular Necrosis

2022-UHC-826 Surgery of the Elbow 11/2/22 12/17/22 Pending

Surgery of the Elbow

2022-HBL-1076 Chelation Therapy 11/2/22 12/17/22 Pending

Chelation Therapy

2022-HBL-1149 Colonoscopy 11/2/22 12/17/22 Pending

Colonoscopy

2022-ABH-1421 In Lieu of services Policy 11/2/22 12/17/22 Pending

In Lieu of services Policy

2022-HBL-1462 Nasal Valve Repair 11/2/22 12/17/22 Pending

Nasal Valve Repair

2022-HBL-1463 Nucleic Acid Amplification Tests Using Algorithmic Analysis for the Diagnosis of Bacterial Vaginosis 11/2/22 12/17/22 Pending

Nucleic Acid Amplification Tests Using Algorithmic Analysis for the Diagnosis of Bacterial Vaginosis

2022-HBL-1464 Gene Therapy for Spinal Muscular Atrophy 11/2/22 12/17/22 Pending

Gene Therapy for Spinal Muscular Atrophy

2022-HBL-1465 Gene Therapy for Cerebral Adrenoleukodystrophy 11/2/22 12/17/22 Pending

Gene Therapy for Cerebral Adrenoleukodystrophy

2022-UHC-1466 Provider Administered Drugs Site of Care 11/2/22 12/17/22 Pending

Provider Administered Drugs Site of Care

2022-HBL-1467 AIM Perirectal Hydrogel Spacer for Prostate Radiotherapy 11/2/22 12/17/22 Pending

AIM Perirectal Hydrogel Spacer for Prostate Radiotherapy

2022-HBL-1468 MRI Guided High Intensity Focused Ultrasound Ablation for Non-Oncologic Indications 11/2/22 12/17/22 Pending

MRI Guided High Intensity Focused Ultrasound Ablation for Non-Oncologic Indications

2022-HHH-1428.1 HHH Preauthorization and Notification List 10/27/22 12/11/22 Pending

HHH Preauthorization and Notification List

2022-UHC-211 Fecal Calprotectin Testing 10/25/22 12/9/22 Pending

Fecal Calprotectin Testing

2022-UHC-559 Implantable Beta-Emitting Microspheres 10/25/22 12/9/22 Pending

Implantable Beta-Emitting Microspheres

2022-UHC-561 Cognitive Rehabilitation 10/25/22 12/9/22 Pending

Cognitive Rehabilitation

2022-UHC-787 Lithotripsy salivary stones 10/25/22 12/9/22 Pending

Lithotripsy salivary stones

2022-UHC-789 Minimally Invasive Procedures GERD and Achalasia 10/25/22 12/9/22 Pending

Minimally Invasive Procedures GERD and Achalasia

2022-UHC-790 Nerve graft to restore Erectile Function during radical prostatectomy 10/25/22 12/9/22 Pending

Nerve graft to restore Erectile Function during radical prostatectomy

2022-LHCC-982 Outpatient Applied Behavior Analysis Medical Necessity 10/25/22 12/9/22 Pending

Outpatient Applied Behavior Analysis Medical Necessity

2022-HBL-1026 Gene expression profiling for managing breast cancer treatment 10/25/22 12/9/22 Pending

Gene expression profiling for managing breast cancer treatment

2022-HBL-1091 Transcatheter Heart Valve Procedures 10/25/22 12/9/22 Pending

Transcatheter Heart Valve Procedures

2022-HBL-1146 Oral, Pharyngeal and Maxillofacial Surgical treatment for Obstructive Sleep Apnea or Snoring 10/25/22 12/9/22 Pending

Oral, Pharyngeal and Maxillofacial Surgical treatment for Obstructive Sleep Apnea or Snoring

2022-HBL-1159 Endobronchial Valve Devices 10/25/22 12/9/22 Pending

Endobronchial Valve Devices

2022-HBL-1219 Genotype Testing for Individual Genetic Polymorphisms to Determine Drug-Metabolizer Status 10/25/22 12/9/22 Pending

Genotype Testing for Individual Genetic Polymorphisms to Determine Drug-Metabolizer Status

2022-LHCC-1410 Neurofeedback for Behavioral Health Disorders 10/25/22 12/9/22 Pending

Neurofeedback for Behavioral Health Disorders

2022-LHCC-1417 Adult Crisis Stabilization 10/25/22 12/9/22 Pending

Adult Crisis Stabilization

2022-UHC-1461 Unicondylar Spacer Devices for Treatment of Pain or Disability 10/25/22 12/9/22 Pending

Unicondylar Spacer Devices for Treatment of Pain or Disability

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