Louisiana Administrative Code
Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE
Part XXXIII - Behavioral Health Services
Subpart 1 - Healthy Louisiana and Coordinated System of Care Waiver
Chapter 7 - Grievance and Appeals Process
Section XXXIII-703 - Provider Grievance and Appeal Process
Universal Citation: LA Admin Code XXXIII-703
Current through Register Vol. 50, No. 9, September 20, 2024
A. If the provider is filing a grievance or appeal on behalf of the member, the provider shall adhere to the provisions outlined in §701 of this Chapter.
B. The MCO and CSoC contractor must have a grievance and appeals process for claims, medical necessity, and contract disputes for providers in accordance with the contract and department issued guidance.
1. The MCO and CSoC contractor
shall establish and maintain a procedure for the receipt and prompt internal
resolution of all provider initiated grievances and appeals as specified in the
contract and department issued guidance.
2. The grievance and appeals procedures, and
any changes thereto, must be approved in writing by the department prior to
their implementation.
3.
Notwithstanding any MCO, CSoC contractor, or department grievance and appeal
process, nothing contained in any document, including, but not limited to Rule
or contract, shall preclude a provider's right to pursue relief through a court
of appropriate jurisdiction.
4. The
MCO and CSoC contractor shall report on a monthly basis all grievance and
appeals filed and resolutions in accordance with the terms of the contract and
department issued guidance.
AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act
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