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

Managed Care Policies & Procedures Archive continued