Effective 1/1/2024 Written Request Acknowledgment Available

Fecha: 05/01/24

Effective 1/1/2024 per Louisiana Legislation Act No 312 providers will be able to request written acknowledgment of each document submitted during the utilization review process. A Request for written acknowledgment must be completed and included as an attachment along with all documents being submitted for review. The form is available on the Ambetter from Louisiana Healthcare Connections website: https://ambetter.louisianahealthconnect.com/provider-resources/manuals-and-forms.html. 

"Utilization review" means a set of formal techniques designed to monitor the use of or evaluate the clinical necessity, appropriateness, efficacy, or efficiency of healthcare services, procedures, or settings. Techniques for application include but are not limited to ambulatory review, second opinion, certification, concurrent review, case management, discharge planning, reviews to determine prior authorization, and retrospective review. "Utilization review" does not include elective requests for clarification of coverage.