Medicaid Managed Care Policies & Procedures Archive (2022)

"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:

Item Number	Policy/Procedure	Date Posted	Comment Period Closed	Status	Document Links
2022-UHC-224	Visual Information Processing Evaluation and Orthoptic and Vision Therapy	12/29/22	2/12/23	Approved	Visual Information Processing Evaluation and Orthoptic and Vision Therapy
2022-ACLA-260	Continuity of Care	12/29/22	2/12/23	Complete	Continuity of Care
2022-ACLA-268	Continuity for BH Care	12/29/22	2/12/23	Complete	Continuity for BH Care
2022-UHC-949	Chemotherapy-Observation or Inpatient Hospitalization	12/29/22	2/12/23	Approved	Chemotherapy-Observation or Inpatient Hospitalization
2022-LHCC-1269	Gender Affirming Procedures	12/29/22	2/12/23	Approved	Gender Affirming Procedures
2022-LHCC-1416	Transportation Policy	12/29/22	2/12/23	Approved	Transportation Policy
2022-HHH-1460	Doula Services (ILO)	12/29/22	2/12/23	Approved	Doula Services (ILO)
2022-ACLA-1735	PCP Assignment Dispute Process	12/29/22	2/12/23	Approved	PCP Assignment Dispute Process
2022-ACLA-1736	Provider Complaint and Dispute	12/29/22	2/12/23	Approved	Provider Complaint and Dispute
2022-UHC-1737	Computer-Assisted Surgical Navigation for Musculoskeletal Procedures	12/29/22	2/12/23	Approved	Computer-Assisted Surgical Navigation for Musculoskeletal Procedures
2022-LDH-16	MCO Manual > Part 4: Services > In Lieu of Services > Behavioral Health Services (Proposed effective date = 1/1/2023)	12/22/22	2/5/23	Approved	Therapeutic Day Center
2022-LHCC-1587	Member Experience Analysis	12/21/22	2/4/23	Approved	Member Experience Analysis
2022-LHCC-140	Timeliness of UM Decisions	12/21/22	2/4/23	Approved	Timeliness of UM Decisions
2022-ABH-261	Coordination of Member Care	12/21/22	2/4/23	Complete	Coordination of Member Care
2022-ABH-265	Integrated Care Management	12/21/22	2/4/23	Complete	Integrated Care Management
2022-HBL-589	Non-Covered and Cost Effective Alternative Services	12/21/22	2/4/23	Complete	Non-Covered and Cost Effective Alternative Services
2022-LHCC-914	Care Plan Development and Implementation	12/21/22	2/4/23	Approved	Care Plan Development and Implementation
2022-HBL-1726	PRTF	12/21/22	2/4/23	Approved	PRTF
2022-LHCC-1513	Continuity and Coordination of Services	12/19/22	2/2/23	Complete	Continuity and Coordination of Services
2022-LHCC-1516	Overisght of Delegated Credentialing	12/19/22	2/2/23	Complete	Overisght of Delegated Credentialing
2022-LHCC-1517	Certificate of Credible Coverage	12/19/22	2/2/23	Complete	Certificate of Credible Coverage
2022-LHCC-1518	Continuity of Operations	12/19/22	2/2/23	Complete	Continuity of Operations
2022-LHCC-1519	Member Rights and Responsibilities	12/19/22	2/2/23	Complete	Member Rights and Responsibilities
2022-LHCC-1520	Disease Management Programs	12/19/22	2/2/23	Approved	Disease Management Programs
2022-LHCC-1522	Notification of Pregnancy (NOP) Policy	12/19/22	2/2/23	Complete	Notification of Pregnancy (NOP) Policy
2022-UHC-1523	Facet Joint and Medial Branch Block Injections for Spinal Pain	12/19/22	2/2/23	Approved	Facet Joint and Medial Branch Block Injections for Spinal Pain
2022-HHH-1580	Personal Care Services (PCS) for Adults with Serious Mental Illness (SMI)	12/19/22	2/2/23	Approved	Personal Care Services (PCS) for Adults with Serious Mental Illness (SMI)
2022-LHCC-1588	Member Advisory of Provider Contract Termination or Limitation Policy	12/19/22	2/2/23	Complete	Member Advisory of Provider Contract Termination or Limitation Policy
2022-LHCC-1700	Care Management Program	12/19/22	2/2/23	Approved	Care Management Program
2022-LHCC-1708	Maternal Child Program NICU Follow-up	12/19/22	2/2/23	Complete	Maternal Child Program NICU Follow-up
2022-LHCC-1709	Transition of Care	12/19/22	2/2/23	Approved	Transition of Care
2022-LHCC-1711	Sympathetic Nerve Block	12/19/22	2/2/23	Approved	Sympathetic Nerve Block
2022-HBL-1713	Behavioral Health Emergency Care	12/19/22	2/2/23	Approved	Behavioral Health Emergency Care
2022-HBL-1714	Case Management	12/19/22	2/2/23	Complete	Case Management
2022-HBL-1716	Continuity of Care	12/19/22	2/2/23	Complete	Continuity of Care
2022-HBL-1717	Utilization Management	12/19/22	2/2/23	Complete	Utilization Management
2022-HBL-1720	MCO Manual Revision	12/19/22	2/2/23	Complete	MCO Manual Revision
2022-HBL-1721	Medical Record Review	12/19/22	2/2/23	Complete	Medical Record Review
2022-HBL-1722	Membership Load	12/19/22	2/2/23	Complete	Membership Load
2022-HBL-1723	PCP Selection, Assignment, and Change Request	12/19/22	2/2/23	Complete	PCP Selection, Assignment, and Change Request
2022-HBL-1724	Provider Claim Payment Dispute Process	12/19/22	2/2/23	Complete	Provider Claim Payment Dispute Process
2022-HBL-1725	Provider Complaint System	12/19/22	2/2/23	Complete	Provider Complaint System
2022-HBL-1727	Quarterly Enrollee Reassignment Analysis	12/19/22	2/2/23	Complete	Quarterly Enrollee Reassignment Analysis
2022-HBL-1728	Standing Referral	12/19/22	2/2/23	Complete	Standing Referral
2022-HBL-1729	Tiered Case Management	12/19/22	2/2/23	Complete	Tiered Case Management
2022-HBL-1730	Timely Notification of Participating Provider Termination	12/19/22	2/2/23	Complete	Timely Notification of Participating Provider Termination
2022-HBL-1731	Specialty Referral	12/19/22	2/2/23	Complete	Specialty Referral
2022-LHCC-42	Member Services Calls Hotline Policy	12/19/22	2/2/23	Complete	Member Services Calls Hotline Policy
2022-LHCC-54	Primary Care Provider (PCP) Selection and Change	12/19/22	2/2/23	Complete	Primary Care Provider (PCP) Selection and Change
2022-LHCC-55	LHCC revisions to Operations policies - Call Line PP Provider Services Calls Hotline	12/19/22	2/2/23	Complete	LHCC revisions to Operations policies - Call Line PP Provider Services Calls Hotline
2022-LHCC-108	Women’s Health Services	12/19/22	2/2/23	Approved	Women’s Health Services
2022-LHCC-109	Clinical Decision Criteria and Application	12/19/22	2/2/23	Complete	Clinical Decision Criteria and Application
2022-UHC-217	Omnibus Codes	12/19/22	2/2/23	Approved	Omnibus Codes
2022-LHCC-329	Adverse Determinations	12/19/22	2/2/23	Approved	Adverse Determinations
2022-LHCC-419	Provider Termination	12/19/22	2/2/23	Approved	Provider Termination
2022-LHCC-422	Network Development and Management	12/19/22	2/2/23	Complete	Network Development and Management
2022-LHCC-429	UM Program Description  SEE 107 & 139	12/19/22	2/2/23	Complete	UM Program Description  SEE 107 & 139
2022-LHCC-430	Covered Benefits and Services	12/19/22	2/2/23	Complete	Covered Benefits and Services
2022-LHCC-499	Retrospective Review For Services Requiring Authorizations	12/19/22	2/2/23	Complete	Retrospective Review For Services Requiring Authorizations
2022-LHCC-502	Clinical Information and Documentation Policy	12/19/22	2/2/23	Complete	Clinical Information and Documentation Policy
2022-LHCC-532	Appropriate UM Professionals	12/19/22	2/2/23	Approved	Appropriate UM Professionals
2022-LHCC-603	Coordinated System of Care (CSoC) PP	12/19/22	2/2/23	Approved	Coordinated System of Care (CSoC) PP
2022-LHCC-606	Grievance Process	12/19/22	2/2/23	Approved	Grievance Process
2022-LHCC-680	Provider Reimbursement	12/19/22	2/2/23	Complete	Provider Reimbursement
2022-LHCC-695	Abdomen CT	12/19/22	2/2/23	Approved	Abdomen CT
2022-LHCC-696	Abdomen CT Angiography	12/19/22	2/2/23	Approved	Abdomen CT Angiography
2022-LHCC-721	CT (Virtual) Colonoscopy	12/19/22	2/2/23	Approved	CT (Virtual) Colonoscopy
2022-LHCC-829	Interrater Reliability - Act 421	12/19/22	2/2/23	Approved	Interrater Reliability - Act 421
2022-ACLA-847	Lumbar Spine MRI	12/19/22	2/2/23	Approved	Lumbar Spine MRI
2022-LHCC-897	Return Mail Policy and Procedure	12/19/22	2/2/23	Complete	Return Mail Policy and Procedure
2022-LHCC-903	New member Welcome Calls	12/19/22	2/2/23	Complete	New member Welcome Calls
2022-LHCC-904	Hearing Impaired/Language Specific Interpreter Services	12/19/22	2/2/23	Complete	Hearing Impaired/Language Specific Interpreter Services
2022-LHCC-908	Return Call Voicemail	12/19/22	2/2/23	Complete	Return Call Voicemail
2022-LHCC-910	Network Selection and Retention	12/19/22	2/2/23	Complete	Network Selection and Retention
2022-LHCC-912	Medical Management	12/19/22	2/2/23	Approved	Medical Management
2022-LHCC-913	PASRR Level II Evaluations	12/19/22	2/2/23	Approved	PASRR Level II Evaluations
2022-LHCC-922	Fraud, Waste, and Abuse Plan	12/19/22	2/2/23	Complete	Fraud, Waste, and Abuse Plan
2022-LHCC-927	Conducting Health Record Reviews	12/19/22	2/2/23	Approved	Conducting Health Record Reviews
2022-LHCC-965	Member Provider Call Audit and Quality Criteria and Protocol	12/19/22	2/2/23	Complete	Member Provider Call Audit and Quality Criteria and Protocol
2022-UHC-1122	Percutaneous Vertebroplasty and Kyphoplasty	12/19/22	2/2/23	Approved	Percutaneous Vertebroplasty and Kyphoplasty
2022-UHC-1350	Gender Dysphoria Treatment	12/19/22	2/2/23	Approved	Gender Dysphoria Treatment
2022-LHCC-1449	Practitioner Credentialing and Recredentialing	12/19/22	2/2/23	Approved	Practitioner Credentialing and Recredentialing
2022-LHCC-129	Provider Directories	11/30/22	1/14/23	Approved	Provider Directories
2022-LHCC-900	Emergency Department Diversion	11/30/22	1/14/23	Approved	Emergency Department Diversion
2022-LHCC-1109	Diaphragmatic/Phrenic Nerve Stimulation	11/30/22	1/14/23	Approved	Diaphragmatic/Phrenic Nerve Stimulation
2022-LHCC-1111	Thyroid Insulin Test in Pediatrics	11/30/22	1/14/23	Approved	Thyroid Insulin Test in Pediatrics
2022-LHCC-1112	Digital EEG Analysis	11/30/22	1/14/23	Approved	Digital EEG Analysis
2022-LHCC-1113	Cardiac Biomarker Testing	11/30/22	1/14/23	Approved	Cardiac Biomarker Testing
2022-LHCC-1115	Vitamin D Testing in Pediatrics	11/30/22	1/14/23	Approved	Vitamin D Testing in Pediatrics
2022-LHCC-1211	Reduction Mammoplasty and Gynecomastia Surgery	11/30/22	1/14/23	Approved	Reduction Mammoplasty and Gynecomastia Surgery
2022-LHCC-1274	Osteogenic Stimulation	11/30/22	1/14/23	Approved	Osteogenic Stimulation
2022-LHCC-1278	Evoked Potential Testing	11/30/22	1/14/23	Approved	Evoked Potential Testing
2022-LHCC-1279	Measure Serum 1.25 Vit D	11/30/22	1/14/23	Approved	Measure Serum 1.25 Vit D
2022-LHCC-1280	EEG in the Evaluation of Headache	11/30/22	1/14/23	Approved	EEG in the Evaluation of Headache
2022-LHCC-1284	Preventive Health and Clinical Practice	11/30/22	1/14/23	Approved	Preventive Health and Clinical Practice
2022-LHCC-1361	Pediatric Heart Transplant	11/30/22	1/14/23	Approved	Pediatric Heart Transplant
2022-LHCC-1389	Endometrial Ablation	11/30/22	1/14/23	Approved	Endometrial Ablation
2022-ABH-1451	Crisis Stabilization Services for Adults	11/30/22	1/14/23	Approved	Crisis Stabilization Services for Adults
2022-LHCC-1470	Assertive Community Treatment	11/30/22	1/14/23	Approved	Assertive Community Treatment
2022-LHCC-1479	High Complexity Medical Decision-Making	11/30/22	1/14/23	Approved	High Complexity Medical Decision-Making
2022-LHCC-1701	Outpatient Testing for DOA (Drugs of Use)	11/30/22	1/14/23	Approved	Outpatient Testing for DOA (Drugs of Use)
2022-LHCC-1702	Holter Monitor	11/30/22	1/14/23	Approved	Holter Monitor
2022-LHCC-1703	Pediatric Kidney Transplant	11/30/22	1/14/23	Approved	Pediatric Kidney Transplant
2022-LHCC-1704	Helicobacter Pylori Serology Testing	11/30/22	1/14/23	Approved	Helicobacter Pylori Serology Testing
2022-LHCC-1705	Invasive and Non-Invasive Home Ventilator	11/30/22	1/14/23	Approved	Invasive and Non-Invasive Home Ventilator
2022-LHCC-1706	Wireless Motility Capsule	11/30/22	1/14/23	Approved	Wireless Motility Capsule
2022-HHH-1666	Speech Therapy Clinical Coverage Policy	11/28/22	1/12/23	Complete	Speech Therapy Clinical Coverage Policy
2022-HHH-1667	Ventilator Assist Devices Clinical Coverage policy	11/28/22	1/12/23	Complete	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	Complete	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	Complete	Wound Care Clinical Coverage policy
2022-HHH-1672	Delegation Compliance NMR and Focus Health	11/28/22	1/12/23	Complete	Delegation Compliance NMR and Focus Health
2022-HHH-1675	Focus Health Security Policy & Procedure	11/28/22	1/12/23	Complete	Focus Health Security Policy & Procedure
2022-HHH-1678	NMR Federal Exclusion Compliance Policy	11/28/22	1/12/23	Complete	NMR Federal Exclusion Compliance Policy
2022-HHH-1679	Permanent Supportive Housing (PSH) Services	11/28/22	1/12/23	Complete	Permanent Supportive Housing (PSH) Services
2022-HHH-1681	Health Record Review Strategy	11/28/22	1/12/23	Complete	Health Record Review Strategy
2022-HHH-1688	Drug Coverage Policy	11/28/22	1/12/23	Complete	Drug Coverage Policy
2022-HHH-1689	Pre Del- Results	11/28/22	1/12/23	Complete	Pre Del- Results
2022-HHH-1690	Board Certified Staff Listing	11/28/22	1/12/23	Complete	Board Certified Staff Listing
2022-HHH-1691	Delegation Compliance Audit Summary Report	11/28/22	1/12/23	Complete	Delegation Compliance Audit Summary Report
2022-HHH-1692	UM-2 Staffing NDT Additions	11/28/22	1/12/23	Complete	UM-2 Staffing NDT Additions
2022-HHH-1693	UM-05 UM Org Chart	11/28/22	1/12/23	Complete	UM-05 UM Org Chart
2022-HHH-1694	Eligibility and Verification	11/28/22	1/12/23	Complete	Eligibility and Verification
2022-HHH-1695	Redacted	11/28/22	1/12/23	Complete	Redacted
2022-HHH-1696	Focus Health Financial Incentive Policy	11/28/22	1/12/23	Complete	Focus Health Financial Incentive Policy
2022-HHH-1697	NMR Appropriate Professionals	11/28/22	1/12/23	Complete	NMR Appropriate Professionals
2022-HHH-1698	Delegation Compliance NCH Management-Evolent	11/28/22	1/12/23	Complete	Delegation Compliance NCH Management-Evolent
2022-HHH-1699	Health Record Review Tool	11/28/22	1/12/23	Complete	Health Record Review Tool
2022-HHH-1644	Blepharoplasty, Blepharoptosis Repair and Brow Lift Clinical Coverage	11/28/22	1/12/23	Complete	Blepharoplasty, Blepharoptosis Repair and Brow Lift Clinical Coverage
2022-HHH-1645	Breast Surgery Clinical Coverage Policy	11/28/22	1/12/23	Complete	Breast Surgery Clinical Coverage Policy
2022-HHH-1646	Cochlear Implant Clinical Coverage Policy	11/28/22	1/12/23	Complete	Cochlear Implant Clinical Coverage Policy
2022-HHH-1647	Continuous Subcutaneous Insulin External Infusion Pump Clinical Coverage Policy	11/28/22	1/12/23	Complete	Continuous Subcutaneous Insulin External Infusion Pump Clinical Coverage Policy
2022-HHH-1649	Delegation Compliance UM.15 NCH	11/28/22	1/12/23	Complete	Delegation Compliance UM.15 NCH
2022-HHH-1650	Delegation Compliance UM.15 NMR	11/28/22	1/12/23	Complete	Delegation Compliance UM.15 NMR
2022-HHH-1651	Gender Affirmation Surgery Clinical Coverage Policy	11/28/22	1/12/23	Complete	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	Complete	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	Complete	Hearing Aids Clinical Policy
2022-HHH-1654	High Frequency Chest Wall Oscillation Devices Clinical Coverage Policy	11/28/22	1/12/23	Complete	High Frequency Chest Wall Oscillation Devices Clinical Coverage Policy
2022-HHH-1655	Home Health Clinical Coverage Policy	11/28/22	1/12/23	Complete	Home Health Clinical Coverage Policy
2022-HHH-1656	Hospice Clinical Coverage Policy	11/28/22	1/12/23	Complete	Hospice Clinical Coverage Policy
2022-HHH-1657	Hospital Bed Clinical Coverage Policy	11/28/22	1/12/23	Complete	Hospital Bed Clinical Coverage Policy
2022-HHH-1659	Inhaled Nitric Oxide Clinical Coverage Policy	11/28/22	1/12/23	Complete	Inhaled Nitric Oxide Clinical Coverage Policy
2022-HHH-1660	Intrathecal Baclofen Therapy Clinical Coverage Policy	11/28/22	1/12/23	Complete	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	Complete	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	Complete	Osteogenic Bone Growth Stimulators
2022-HHH-1663	Personal Care Services (PCS) Clinical Coverage Policy	11/28/22	1/12/23	Complete	Personal Care Services (PCS) Clinical Coverage Policy
2022-HHH-1664	Pediatric Day Health Care Clinical Coverage Policy	11/28/22	1/12/23	Complete	Pediatric Day Health Care Clinical Coverage Policy
2022-HHH-1665	Physical and Occupational Therapy Clinical Coverage Policy	11/28/22	1/12/23	Complete	Physical and Occupational Therapy Clinical Coverage Policy
2022-HHH-1621	Timeliness of UM Determinations and Notifications UM8	11/28/22	1/12/23	Complete	Timeliness of UM Determinations and Notifications UM8
2022-HHH-1622	Continuity of Care and Care Transitions UM8	11/28/22	1/12/23	Complete	Continuity of Care and Care Transitions UM8
2022-HHH-1623	Medical Necessity Appropriateness Case Processing UM8	11/28/22	1/12/23	Complete	Medical Necessity Appropriateness Case Processing UM8
2022-HHH-1624	Fraud, Waste, and Abuse Policy UM8	11/28/22	1/12/23	Complete	Fraud, Waste, and Abuse Policy UM8
2022-HHH-1625	Confidentiality Policy UM8	11/28/22	1/12/23	Complete	Confidentiality Policy UM8
2022-HHH-1626	Inter Rater Reliability Assessment - Clinical Staff	11/28/22	1/12/23	Complete	Inter Rater Reliability Assessment - Clinical Staff
2022-HHH-1627	Standard Pre-Service Request for Authorization	11/28/22	1/12/23	Complete	Standard Pre-Service Request for Authorization
2022-HHHH-1628	Utilization Management Criteria Development	11/28/22	1/12/23	Complete	Utilization Management Criteria Development
2022-HHH-1629	Over and Under Utilization	11/28/22	1/12/23	Complete	Over and Under Utilization
2022-HHH-1630	Retrospective Utilization Review	11/28/22	1/12/23	Complete	Retrospective Utilization Review
2022-HHH-1631	Guidelines for Initial Screening	11/28/22	1/12/23	Complete	Guidelines for Initial Screening
2022-HHH-1632	Inter Rater Reliability Assessment - Non-Clinical Staff	11/28/22	1/12/23	Complete	Inter Rater Reliability Assessment - Non-Clinical Staff
2022-HHH-1633	Medical Necessity Determination Process	11/28/22	1/12/23	Complete	Medical Necessity Determination Process
2022-HHH-1634	Timeframes for Completing the Independent Review Process	11/28/22	1/12/23	Complete	Timeframes for Completing the Independent Review Process
2022-HHH-1635	Timeliness of UM Decisions for Delegated UM Cases	11/28/22	1/12/23	Complete	Timeliness of UM Decisions for Delegated UM Cases
2022-HHH-1636	Utilization Management Clinical Practice Guidelines	11/28/22	1/12/23	Complete	Utilization Management Clinical Practice Guidelines
2022-HHH-1639	New Hire MAP	11/28/22	1/12/23	Complete	New Hire MAP
2022-HHH-1640	Delegation Compliance UM13	11/28/22	1/12/23	Complete	Delegation Compliance UM13
2022-HHH-1642	ABA Clinical Coverage	11/28/22	1/12/23	Complete	ABA Clinical Coverage
2022-HHH-1643	Bariatric Surgery Clinical Coverage Policy	11/28/22	1/12/23	Complete	Bariatric Surgery Clinical Coverage Policy
2022-HHH-1427	Medication Preauthorization and Notification List	11/28/22	1/12/23	Complete	Medication Preauthorization and Notification List
2022-HHH-1591	Enrollee Satisfaction Surveys	11/28/22	1/12/23	Complete	Enrollee Satisfaction Surveys
2022-HHH-1592	Health Record Review Strategy	11/28/22	1/12/23	Complete	Health Record Review Strategy
2022-HHH-1593	Provider Manual	11/28/22	1/12/23	Complete	Provider Manual
2022-HHH-1594	Continuity of Care Claims Process and Guidelines	11/28/22	1/12/23	Complete	Continuity of Care Claims Process and Guidelines
2022-HHH-1595	Permanent Supportive Housing Job Description	11/28/22	1/12/23	Complete	Permanent Supportive Housing Job Description
2022-HHH-1597	Delegation Compliance Focus Health UM 2	11/28/22	1/12/23	Complete	Delegation Compliance Focus Health UM 2
2022-HHH-1598	Delegation Compliance Network Medical Review UM 2	11/28/22	1/12/23	Complete	Delegation Compliance Network Medical Review UM 2
2022-HHH-1599	New Century Health Utilization Management Plan UM 2	11/28/22	1/12/23	Complete	New Century Health Utilization Management Plan UM 2
2022-HHH-1601	Delegation Compliance Network Medical Review UM 3	11/28/22	1/12/23	Complete	Delegation Compliance Network Medical Review UM 3
2022-HHH-1605	Delegation Compliance Network Medical Review UM 4	11/28/22	1/12/23	Complete	Delegation Compliance Network Medical Review UM 4
2022-HHH-1606	Louisiana UM Program Description	11/28/22	1/12/23	Complete	Louisiana UM Program Description
2022-HHH-1610	UM Org Chart	11/28/22	1/12/23	Complete	UM Org Chart
2022-HHH-1611	Clinical Criteria for Delegated UM Decisions	11/28/22	1/12/23	Complete	Clinical Criteria for Delegated UM Decisions
2022-HHH-1613	UM8 Confidentiality of PHI	11/28/22	1/12/23	Complete	UM8 Confidentiality of PHI
2022-HHH-1614	UM8 Decision Notice	11/28/22	1/12/23	Complete	UM8 Decision Notice
2022-HHH-1615	UM8 Denial Notices in Delegated UM Cases	11/28/22	1/12/23	Complete	UM8 Denial Notices in Delegated UM Cases
2022-HHH-1617	Abortion, Hysterectomy and Sterilization UM8	11/28/22	1/12/23	Complete	Abortion, Hysterectomy and Sterilization UM8
2022-HHH-1618	Non-Emergency Ambulance Transportation UM8	11/28/22	1/12/23	Complete	Non-Emergency Ambulance Transportation UM8
2022-HHH-1619	Permanent Supportive Housing (PSH) Services UM8	11/28/22	1/12/23	Complete	Permanent Supportive Housing (PSH) Services UM8
2022-UHC-478	Obstructive and Central Sleep Apnea Treatment	11/18/22	1/2/23	Approved	Obstructive and Central Sleep Apnea Treatment
2022-UHC-490	Cardiovascular Disease Risk Tests	11/18/22	1/2/23	Approved	Cardiovascular Disease Risk Tests
2022-HBL-1023	Genetic Testing for Inherited Diseases	11/18/22	1/2/23	Approved	Genetic Testing for Inherited Diseases
2022-UHC-1589	Surgical Treatment of Lymphedema	11/18/22	1/2/23	Approved	Surgical Treatment of Lymphedema
2022-LHCC-1504	Reporting the Global Maternity Package	11/18/22	1/2/23	Complete	Reporting the Global Maternity Package
2022-LHCC-1505	Moderate Conscious Sedation	11/18/22	1/2/23	Complete	Moderate Conscious Sedation
2022-LHCC-1506	Never Paid Events	11/18/22	1/2/23	Complete	Never Paid Events
2022-LHCC-1507	Clinical Validation of Modifier 59	11/18/22	1/2/23	Complete	Clinical Validation of Modifier 59
2022-LHCC-1508	Intravenous Hydration	11/18/22	1/2/23	Complete	Intravenous Hydration
2022-LHCC-1509	Clinical Validation of Modifier 25	11/18/22	1/2/23	Complete	Clinical Validation of Modifier 25
2022-LHCC-1510	EM Bundling with Labs and Radiology	11/18/22	1/2/23	Complete	EM Bundling with Labs and Radiology
2022-LHCC-1511	Unlisted Procedure Codes	11/18/22	1/2/23	Complete	Unlisted Procedure Codes
2022-LHCC-1512	Maximum Units of Service	11/18/22	1/2/23	Complete	Maximum Units of Service
2022-LHCC-1514	Technology Supported Authorization Screening	11/18/22	1/2/23	Complete	Technology Supported Authorization Screening
2022-LHCC-1515	Temporary Limited Authorization Reviews	11/18/22	1/2/23	Complete	Temporary Limited Authorization Reviews
2022-LHCC-1524	Posterior Tibial Nerve Stimulation for Voiding Dysfunction	11/18/22	1/2/23	Approved	Posterior Tibial Nerve Stimulation for Voiding Dysfunction
2022-LHCC-1525	Intradiscal Steroid Injections for Pain Management	11/18/22	1/2/23	Approved	Intradiscal Steroid Injections for Pain Management
2022-LHCC-1526	Trigger Point Injections	11/18/22	1/2/23	Approved	Trigger Point Injections
2022-LHCC-1527	Nerve Blocks and Neurolysis for Pain Management	11/18/22	1/2/23	Approved	Nerve Blocks and Neurolysis for Pain Management
2022-LHCC-1483	Inpatient Consultation	11/18/22	1/2/23	Complete	Inpatient Consultation
2022-LHCC-1484	Status B Bundled Services	11/18/22	1/2/23	Complete	Status B Bundled Services
2022-LHCC-1485	Unbundled Surgical Procedures	11/18/22	1/2/23	Complete	Unbundled Surgical Procedures
2022-LHCC-1486	Post-operative Visits	11/18/22	1/2/23	Complete	Post-operative Visits
2022-LHCC-1488	Unbundled Professional Services	11/18/22	1/2/23	Complete	Unbundled Professional Services
2022-LHCC-1489	Multiple CPT Code Replacement	11/18/22	1/2/23	Complete	Multiple CPT Code Replacement
2022-LHCC-1490	Transgender Related Services	11/18/22	1/2/23	Complete	Transgender Related Services
2022-LHCC-1491	NCCI Unbunding	11/18/22	1/2/23	Complete	NCCI Unbunding
2022-LHCC-1492	New Patient	11/18/22	1/2/23	Complete	New Patient
2022-LHCC-1493	Supplied billed on Same day as Surgery	11/18/22	1/2/23	Complete	Supplied billed on Same day as Surgery
2022-LHCC-1494	Assistant Surgeon	11/18/22	1/2/23	Complete	Assistant Surgeon
2022-LHCC-1495	Add-on Code Billed without Primary Code	11/18/22	1/2/23	Complete	Add-on Code Billed without Primary Code
2022-LHCC-1496	Hospital Visit Codes Billed with Labs	11/18/22	1/2/23	Complete	Hospital Visit Codes Billed with Labs
2022-LHCC-1497	Modifier to Procedure Code Validation	11/18/22	1/2/23	Complete	Modifier to Procedure Code Validation
2022-LHCC-1498	Professional Component Modifier	11/18/22	1/2/23	Complete	Professional Component Modifier
2022-LHCC-1499	Clean Claims Policy	11/18/22	1/2/23	Complete	Clean Claims Policy
2022-LHCC-1500	Pulse Oximetry with Office Visits	11/18/22	1/2/23	Complete	Pulse Oximetry with Office Visits
2022-LHCC-1501	Distinct Procedural Modifiers	11/18/22	1/2/23	Complete	Distinct Procedural Modifiers
2022-LHCC-1502	Professional Services Billed with Labs	11/18/22	1/2/23	Complete	Professional Services Billed with Labs
2022-LHCC-1503	Inpatient Only Procedures	11/18/22	1/2/23	Complete	Inpatient Only Procedures
2022-LHCC-315	Testing Select GU Conditions	11/18/22	1/2/23	Approved	Testing Select GU Conditions
2022-UHC-476	Cytological Examination of Breast Fluids for Cancer Screening or Diagnosis	11/18/22	1/2/23	Approved	Cytological Examination of Breast Fluids for Cancer Screening or Diagnosis
2022-UHC-578	Thermography	11/18/22	1/2/23	Approved	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	Approved	Assertive Community Treatment
2022-LHCC-991	Concurrent Review	11/18/22	1/2/23	Complete	Concurrent Review
2022-LHCC-1228	Sacroiliac Joint Interventions for Pain Management	11/18/22	1/2/23	Approved	Sacroiliac Joint Interventions for Pain Management
2022-LHCC-1265	Vagus Nerve Stimulation	11/18/22	1/2/23	Approved	Vagus Nerve Stimulation
2022-LHCC-1388	Code Edting Overview	11/18/22	1/2/23	Complete	Code Edting Overview
2022-HBL-1409	Mods 25 and 57: Eval and Mgmt with Global Procedure	11/18/22	1/2/23	Approved	Mods 25 and 57: Eval and Mgmt with Global Procedure
2022-LHCC-1415	Pulmonary Function Testing	11/18/22	1/2/23	Approved	Pulmonary Function Testing
2022-LHCC-1472	Transparency Policy: Place of Service Mismatch	11/18/22	1/2/23	Complete	Transparency Policy: Place of Service Mismatch
2022-LHCC-1474	Not medically Necessary Inpatient Professional Services	11/18/22	1/2/23	Complete	Not medically Necessary Inpatient Professional Services
2022-LHCC-1475	Urine Specimen Validity Testing	11/18/22	1/2/23	Complete	Urine Specimen Validity Testing
2022-LHCC-1476	Status P Bundled Services	11/18/22	1/2/23	Complete	Status P Bundled Services
2022-LHCC-1477	Duplicate Primary Code Billing	11/18/22	1/2/23	Complete	Duplicate Primary Code Billing
2022-LHCC-1478	Visits on Same Day as Surgery	11/18/22	1/2/23	Complete	Visits on Same Day as Surgery
2022-LHCC-1480	Pre-operative Visits	11/18/22	1/2/23	Complete	Pre-operative Visits
2022-LHCC-1481	Outpatient Consultation	11/18/22	1/2/23	Complete	Outpatient Consultation
2022-LHCC-1482	Modifier Date of Service Validation	11/18/22	1/2/23	Complete	Modifier Date of Service Validation
2022-HHH-1570-NEW	Covered Benefits and Services	11/17/22	1/1/23	Complete	Covered Benefits and Services
2022-HHH-1571-NEW	Non-Emergency Ambulance Transportation	11/17/22	1/1/23	Complete	Non-Emergency Ambulance Transportation
2022-HHH-1572-NEW	Permanent Supportive Housing	11/17/22	1/1/23	Denied	Permanent Supportive Housing
2022-HHH-1573-NEW	Psychiatric Residential Treatment Facility (PRTF)	11/17/22	1/1/23	Denied	Psychiatric Residential Treatment Facility (PRTF)
2022-HHH-1574-NEW	Timeliness of UM Determinations and Notifications	11/17/22	1/1/23	Complete	Timeliness of UM Determinations and Notifications
2022-HHH-1575-NEW	Access and Attitude Complaints	11/17/22	1/1/23	Complete	Access and Attitude Complaints
2022-HHH-1576-NEW	Observation Level of Care	11/17/22	1/1/23	Complete	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	Complete	PCP Attribution Dispute Process
2022-HHH-1579-NEW	Peer Support Services	11/17/22	1/1/23	Denied	Peer Support Services
2022-HHH-1580-NEW	Personal Care Services (PCS) for Adults with Serious Mental Illness (SMI)	11/17/22	1/1/23	Complete	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	Complete	Utilization Management Inter-Rate Reliability
2022-HHH-1582-NEW	Psychiatric Residential Treatment Facilities	11/17/22	1/1/23	Denied	Psychiatric Residential Treatment Facilities
2022-HHH-1583-NEW	Review for Readmission Workflow	11/17/22	1/1/23	Complete	Review for Readmission Workflow
2022-HHH-1584-NEW	Therapeutic Group Therapy	11/17/22	1/1/23	Complete	Therapeutic Group Therapy
2022-HHH-1585-NEW	Timely Access to Care Mystery Shopper Process	11/17/22	1/1/23	Complete	Timely Access to Care Mystery Shopper Process
2022-HHH-1586-NEW	Justice Enollees Enrollment Process	11/17/22	1/1/23	Complete	Justice Enollees Enrollment Process
2022-HHH-1550-NEW	Special Population: AJ vs LDH Liaison Process	11/17/22	1/1/23	Complete	Special Population: AJ vs LDH Liaison Process
2022-HHH-1551-NEW	Chisolm CM Prior Authorization Liaison (PAL) Review	11/17/22	1/1/23	Complete	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	Complete	Coordinated Systems of Care (CSoC) Care Management Process
2022-HHH-1553-NEW	DOC Pre-Release Program Process	11/17/22	1/1/23	Complete	DOC Pre-Release Program Process
2022-HHH-1554-NEW	Continuity of Care and Care Transitions	11/17/22	1/1/23	Complete	Continuity of Care and Care Transitions
2022-HHH-1555-NEW	Review for Readmission	11/17/22	1/1/23	Complete	Review for Readmission
2022-HHH-1556-NEW	Care Management Program Description	11/17/22	1/1/23	Complete	Care Management Program Description
2022-HHH-1557-NEW	Chisholm Policy	11/17/22	1/1/23	Complete	Chisholm Policy
2022-HHH-1558-NEW	LA MCD Justice Involved Enrollment Process	11/17/22	1/1/23	Complete	LA MCD Justice Involved Enrollment Process
2022-HHH-1559-NEW	Medicaid Encounter Submission - Pharmacy Encounters	11/17/22	1/1/23	Complete	Medicaid Encounter Submission - Pharmacy Encounters
2022-HHH-1560-NEW	Pharmacy Coverage Policy	11/17/22	1/1/23	Complete	Pharmacy Coverage Policy
2022-HHH-1561-NEW	Multi-Systemic Therapy (MST)	11/17/22	1/1/23	Denied	Multi-Systemic Therapy (MST)
2022-HHH-1562-NEW	Overview of Provider Contracting	11/17/22	1/1/23	Complete	Overview of Provider Contracting
2022-HHH-1563-NEW	Complaints on Practitioner Office and Facility Sites	11/17/22	1/1/23	Complete	Complaints on Practitioner Office and Facility Sites
2022-HHH-1564-NEW	Abortion, Hysterectomy and Sterilization	11/17/22	1/1/23	Denied	Abortion, Hysterectomy and Sterilization
2022-HHH-1565-NEW	Chisolm Prior Authorization Liaison (PAL) process	11/17/22	1/1/23	Denied	Chisolm Prior Authorization Liaison (PAL) process
2022-HHH-1566-NEW	Louisiana MTM Medicaid Program	11/17/22	1/1/23	Complete	Louisiana MTM Medicaid Program
2022-HHH-1567-NEW	LA Medicaid PCP Auto Assignment Process	11/17/22	1/1/23	Complete	LA Medicaid PCP Auto Assignment Process
2022-HHH-1568-NEW	CNO On-Going Licensure Monitoring Process	11/17/22	1/1/23	Complete	CNO On-Going Licensure Monitoring Process
2022-HHH-1569-NEW	MD Review of Authorizations	11/17/22	1/1/23	Complete	MD Review of Authorizations
2022-HHH-1530-NEW	300-NCCI MCO Cost Savings	11/17/22	1/1/23	Complete	300-NCCI MCO Cost Savings
2022-HHH-1531-NEW	ABA Clinical Coverage	11/17/22	1/1/23	Denied	ABA Clinical Coverage
2022-HHH-1532-NEW	Assertive Community Treatment (ACT/FACT)	11/17/22	1/1/23	Denied	Assertive Community Treatment (ACT/FACT)
2022-HHH-1533-NEW	Staff Credentials Verification	11/17/22	1/1/23	Complete	Staff Credentials Verification
2022-HHH-1534-NEW	COC Process Map	11/17/22	1/1/23	Complete	COC Process Map
2022-HHH-1535-NEW	Community Brief Crisis Support (CBCS)	11/17/22	1/1/23	Complete	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	Denied	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	Complete	Credentialed Providers/Credentialing Current Monthly Sanction Tracking
2022-HHH-1539-NEW	Crisis Intervention - Follow Up	11/17/22	1/1/23	Complete	Crisis Intervention - Follow Up
2022-HHH-1540-NEW	Crisis Stabilization Services for Adults	11/17/22	1/1/23	Denied	Crisis Stabilization Services for Adults
2022-HHH-1541-NEW	Crisis Stabilization for Children and Adolescents	11/17/22	1/1/23	Complete	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	Denied	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	Complete	EPSDT Personal Care Services (PCS)
2022-HHH-1544-NEW	HCPR & MIT Medicaid Coverage Determination Policy	11/17/22	1/1/23	Complete	HCPR & MIT Medicaid Coverage Determination Policy
2022-HHH-1545-NEW	Humana Healthy Horizons in Louisiana Lock-In Program	11/17/22	1/1/23	Complete	Humana Healthy Horizons in Louisiana Lock-In Program
2022-HHH-1546-NEW	Utilization Management Committee Charter	11/17/22	1/1/23	Complete	Utilization Management Committee Charter
2022-HHH-1547-NEW	Primary Care Physician Designation/Attribution Management	11/17/22	1/1/23	Complete	Primary Care Physician Designation/Attribution Management
2022-HHH-1548-NEW	Individual Placement and Support (IPS)	11/17/22	1/1/23	Denied	Individual Placement and Support (IPS)
2022-HHH-1549-NEW	Chisolm UM SME Process	11/17/22	1/1/23	Complete	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-ABH-1529	Abortion Procedures	11/18/22	N/A	Denied	Abortion Procedures
2022-UHC-201	Apheresis	11/2/22	12/17/22	Approved	Apheresis
2022-UHC-378	Surgery of the Shoulder	11/2/22	12/17/22	Approved	Surgery of the Shoulder
2022-ABH-496	Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR) Services	11/2/22	12/17/22	Approved	Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR) Services
2022-UHC-558	Surgery of the Knee	11/2/22	12/17/22	Approved	Surgery of the Knee
2022-UHC-579	Surgery of the Hip	11/2/22	12/17/22	Approved	Surgery of the Hip
2022-UHC-780	Core Decompression Avascular Necrosis	11/2/22	12/17/22	Approved	Core Decompression Avascular Necrosis
2022-UHC-826	Surgery of the Elbow	11/2/22	12/17/22	Approved	Surgery of the Elbow
2022-HBL-1076	Chelation Therapy	11/2/22	12/17/22	Approved	Chelation Therapy
2022-HBL-1149	Colonoscopy	11/2/22	12/17/22	Approved	Colonoscopy
2022-ABH-1421	In Lieu of services Policy	11/2/22	12/17/22	Approved	In Lieu of services Policy
2022-HBL-1462	Nasal Valve Repair	11/2/22	12/17/22	Approved	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	Approved	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	Approved	Gene Therapy for Spinal Muscular Atrophy
2022-HBL-1465	Gene Therapy for Cerebral Adrenoleukodystrophy	11/2/22	12/17/22	Approved	Gene Therapy for Cerebral Adrenoleukodystrophy
2022-UHC-1466	Provider Administered Drugs Site of Care	11/2/22	12/17/22	Approved	Provider Administered Drugs Site of Care
2022-HBL-1467	AIM Perirectal Hydrogel Spacer for Prostate Radiotherapy	11/2/22	12/17/22	Approved	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	Approved	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	Complete	HHH Preauthorization and Notification List
2022-UHC-211	Fecal Calprotectin Testing	10/25/22	12/9/22	Approved	Fecal Calprotectin Testing
2022-UHC-559	Implantable Beta-Emitting Microspheres	10/25/22	12/9/22	Approved	Implantable Beta-Emitting Microspheres
2022-UHC-561	Cognitive Rehabilitation	10/25/22	12/9/22	Approved	Cognitive Rehabilitation
2022-UHC-787	Lithotripsy salivary stones	10/25/22	12/9/22	Approved	Lithotripsy salivary stones
2022-UHC-789	Minimally Invasive Procedures GERD and Achalasia	10/25/22	12/9/22	Approved	Minimally Invasive Procedures GERD and Achalasia
2022-UHC-790	Nerve graft to restore Erectile Function during radical prostatectomy	10/25/22	12/9/22	Approved	Nerve graft to restore Erectile Function during radical prostatectomy
2022-LHCC-982	Outpatient Applied Behavior Analysis Medical Necessity	10/25/22	12/9/22	Approved	Outpatient Applied Behavior Analysis Medical Necessity
2022-HBL-1026	Gene expression profiling for managing breast cancer treatment	10/25/22	12/9/22	Approved	Gene expression profiling for managing breast cancer treatment
2022-HBL-1091	Transcatheter Heart Valve Procedures	10/25/22	12/9/22	Approved	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	Approved	Oral, Pharyngeal and Maxillofacial Surgical treatment for Obstructive Sleep Apnea or Snoring
2022-HBL-1159	Endobronchial Valve Devices	10/25/22	12/9/22	Approved	Endobronchial Valve Devices
2022-HBL-1219	Genotype Testing for Individual Genetic Polymorphisms to Determine Drug-Metabolizer Status	10/25/22	12/9/22	Approved	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	Approved	Neurofeedback for Behavioral Health Disorders
2022-LHCC-1417	Adult Crisis Stabilization	10/25/22	12/9/22	Approved	Adult Crisis Stabilization
2022-UHC-1461	Unicondylar Spacer Devices for Treatment of Pain or Disability	10/25/22	12/9/22	Approved	Unicondylar Spacer Devices for Treatment of Pain or Disability

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