Get the latest on reimbursement rates, prior authorization updates, CGM devices, Provider Enrollment Portal resources and more
The Louisiana Department of Health (LDH) has recently released several bulletins announcing updates to various policies and programs. We will take action on some claims and make adjustments to affected policies and procedures to adhere to these updated guidelines.
Reimbursement rate updates for pediatric day health care
LDH has updated the reimbursement rate for pediatric day health care (PDHC). The update includes daily, hourly and transportation rates for dates of service on or after July 1, 2022.
Note: We will recycle claims affected by this reimbursement change with dates of service on or after July 1, 2022 and will pay claims at the increased rate.
LDH is in the process of updating rulemaking and the State Plan to accommodate this change. Once approved, the Medicaid Fee-for-Service (FFS) procedure file and fee schedule will be updated to reflect this change. Any questions regarding FFS claims should be directed to Gainwell Provider Relations at 800-473-2783 or 225-924-5040.
For more information, view the LDH bulletin announcing the PDHC update.
Ventilator prior authorization updates
LDH has updated prior authorization requirements for reimbursement of invasive and non-invasive ventilators. Effective Sept. 1, 2022, all approved prior authorizations for ventilators will be valid for a period of 12 months.
At this time, the current ventilator prior authorization criteria will remain the same.
For more information, view the LDH bulletin announcing the ventilator update.
Revised criteria for long-term continuous glucose monitoring devices
LDH has revised the criteria for long-term continuous glucose monitoring (CGM) devices as of Aug. 1, 2022. The CGM device is covered through the durable medical equipment program and prior authorization is required.
Beneficiaries must meet one of the following eligibility criteria:
CGM devices require a prescription and documentation of medical necessity. In addition, beneficiaries who receive this coverage are required to attend regular follow-up visits with a health care provider at a minimum of every 6 months to assess the ongoing benefits. Short-term CGMs will not be considered as a covered device.
Note: We will reprocess and pay any claims that are affected by this change.
For more information, view the LDH bulletin announcing the CGM update.
Smallpox and monkeypox vaccines
The smallpox and monkeypox vaccine (CPT 90611) will be covered for dates of service on and after July 26, 2022. The vaccine is currently provided at no cost to providers by the federal government and therefore the vaccine code shall be reimbursed at $0. Claims will only be reimbursed when the vaccine and vaccine administration are performed, documented and coded appropriately.
United HealthCare will reprocess claims that are impacted by this coverage update.
For more information, view the LDH bulletin regarding smallpox and monkeypox vaccines.
Sterilization consent form revisions
The Office of Population Affairs (OPA) revised and published the sterilization consent form with an updated expiration date of July 31, 2025. The revised form should be used immediately. The prior form will be accepted for consents signed on or before July 31, 2022.
Providers are responsible for using the most current form published on the OPA website on the date the consent is obtained.
For more information, view the LDH bulletin on the sterilization consent form revisions.
Provider Enrollment Portal requirement updates
LDH has revised the requirements for the Louisiana Medicaid Provider Enrollment Portal. The Louisiana Medicaid Provider Enrollment Portal must be used by any providers that care for Medicaid members and file claims with Louisiana Medicaid.
This includes the following types of providers:
All providers, including any new providers enrolling for the first time, will be notified by invitation letter when it is time for them to enroll.
Timeline for completing the enrollment and screening process
Current providers must validate their information and sign the state’s provider participation agreement. The deadline for providers to submit an application to the Provider Enrollment Portal is Sept. 30, 2022. The application deadline applies to providers who received an invitation letter from Gainwell Technologies. Providers must allow several weeks from the time of the application submission to the time that enrollment is considered complete. Claims will be denied beginning Dec. 31, 2022 for providers who have not completed the enrollment process.
New providers will need to complete the credentialing process with MCOs, DBPMs and/or Magellan either concurrent with or after they complete the enrollment process with the state through the Louisiana Medicaid Provider Enrollment Portal. New providers will receive invitation letters when it is their time to enroll.
For more information, view the LDH bulletin announcing the Provider Enrollment Portal updates.
Provider Enrollment Portal resources
A Provider Portal Enrollment Lookup Tool is now available. Providers returned via this search tool will show a status of enrollment complete, action required or currently in process by Gainwell. Providers that show no results are not required to enroll at this time. Data elements that may be used for lookup include NPI, Provider Name, Provider Type, Specialty, Address, City and State, and Zip Code. Any public user can use the tool to check current enrollment status.
Temporary suspension of policy for transfers to lower levels of care
LDH is implementing a temporary suspension to facilitate timely discharges of patients to the lower level of care.
To align with the temporary suspension, effective July 20, 2022 through Aug. 31, 2022, we will not impose prior authorization, utilization, medical necessity, or any related review on the transfer of patients to lower levels of care (e.g., skilled nursing facility, inpatient rehabilitation and long-term acute care) for members being discharged from the hospital.
For more information, view the LDH bulletin announcing the COVID-19 updates.
For answers to specific coverage or claims questions, please call the Provider Call Center at 866-675-1607.