La. Admin. Code tit. 40 § I-4507

Current through Register Vol. 50, No. 9, September 20, 2024

Section I-4507 - Prior Authorization

A. Except in documented emergencies, all equipment, supplies and services described herein, except those specifically noted, must have prior written authorization of the carrier/self-insured employer before reimbursement will be made. Claimants should be notified of this requirement in writing upon the initiation of the claim. Each authorization request must include a prescription or statement of need from the treating physician of record.

B. Prior authorization requests will be approved, denied, or amended and approved by the carrier/self-insured employer. Occasionally, some requests may be returned for further information, explanation, or reports. Once a request is approved, please take great care to bill only for those procedures or services specifically authorized by the carrier/self-insured employer. In addition, please attach the authorization letter to the invoice or enter the prior authorization number in the appropriate field on the invoice.

C. The following must be taken into account when making a prior authorization request.

1. The prescription or the letter of justification from the claimant's physician is the key factor in obtaining prior authorization of the carrier/self-insured employer and reimbursement. For oxygen requests, the type and amount, the frequency, and method of delivery also must be specified. In addition, the physician should list the estimated requirements for ancillary supplies.

2. For approved rentals and supplies, a specific period of authorization will be established based on the recommendation of the physician who issues the prescription. At the end of this initial period, if there is a continuing need for equipment or supplies, it is the provider's responsibility to obtain a new prescription, the prognosis and a new estimate of the period of need. The provider should make the continuing authorization request and attach the prescription.

3. For equipment rental and purchase request, the item's model and serial number and a description of the warranty coverage must be included with the request. The carrier/self-insured employer is authorized to require a consultation prior to approval of any equipment or supplies.

La. Admin. Code tit. 40, § I-4507

Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994).

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.