Louisiana, Washington, D.C., and Mississippi providers: Benefit summary updates

October 2024

We’re updating the benefit summary for Louisiana, Washington, D.C., and Mississippi; however, we won’t change benefit coverages.

Reason for the updates

We want to provide clarification on medically necessary services and materials. These modifications will also aim to eliminate the need for confirmations for the codes below and to clarify what is medically necessary. Currently, you must obtain a confirmation number for the services below and with this change, you’ll no longer have to request confirmations for these services.

We’ll perform these reviews through the claims process, and a valid medical diagnosis is required for payment of any claims that are filed. Additionally, these improvements will reduce the load on providers and improve patient access to care. The standards for diagnostic codes will be included in all medical procedure policies and readily available on our Provider Reference Guide page starting Nov. 1, 2024.

You still can appeal claims and request clinical review of any contested claims. These requests will be reviewed by our Peer Review Committee to determine if they meet the requirements for medical necessity guidelines.

The procedures and states being updated effective Nov. 1, 2024, are as follows:

Louisiana

Mississippi

Washington, D.C.