§ 22:1260.45 — Documentation

Louisiana § 22:1260.45

• Jurisdiction: Louisiana
• Title 22: Insurance

Text

§1260.45. Documentation
When conducting a utilization review, a health insurance issuer shall do all of the
following:
(1) Accept any evidence-based information from a provider that will assist in the
utilization review.
(2) Collect only the information necessary to authorize the service and maintain a
process for the provider to submit the records.
(3) If medical records are requested, require only the portion of the medical record
necessary in that specific case to determine medical necessity or appropriateness of the
service to be delivered, including admission or extension of stay, frequency, or duration of
service.
(4) Base review determinations on the medical information in the enrollee's records
obtained by the health insurance issuer up to the time of the review determination.

Legislative History

Acts 2023, No. 312, §1, eff. Jan. 1, 2024.