Louisiana Prior Authorization Laws for Payers and PBMs
Louisiana has established specific regulations governing prior authorization (PA) processes to promote transparency, ensure timely access to care, and reduce administrative burdens. Let Banjo Health help you be ready.
June 5, 2025
Streamline Compliance and Enhance Efficiency with Banjo Health
Louisiana has established specific regulations governing prior authorization (PA) processes to promote transparency, ensure timely access to care, and reduce administrative burdens. For payers and pharmacy benefit managers (PBMs), adhering to these requirements is essential. Banjo Health offers an intelligent automation platform that aligns with Louisiana's PA regulations, ensuring compliance and operational efficiency.
Key Provisions of Louisiana’s Prior Authorization Regulations
Uniform Prescription Drug Prior Authorization Form: As mandated by Louisiana law, health insurance issuers must utilize a single, uniform prescription drug prior authorization form, jointly developed by the Louisiana Board of Pharmacy and the Louisiana State Board of Medical Examiners. This form should not exceed two pages and must be accessible electronically and via fax. Exceptions apply to specialty drugs and electronic prescriptions.
Transparency Requirements: Health insurance issuers are required to post prior authorization requirements, including clinical criteria and submission standards, on their websites in an easily searchable format. This ensures that healthcare providers have timely access to necessary information.
Timely Communication: If a prior authorization request is denied, the issuer must provide written notice to the requesting provider within three business days, including the rationale and references to applicable laws, regulations, or guidelines.
Louisiana Medicaid Prior Authorization Requirements
The Louisiana Department of Health (LDH) oversees Medicaid services, with specific PA requirements:
- Submission Methods: Providers can submit PA requests via fax, phone, or secure web portals. Electronic submissions are encouraged for efficiency.
- Timelines: Standard PA requests should be submitted at least seven business days before the scheduled service delivery date. Urgent requests should be submitted as soon as the need is identified.
- Emergency Services: Emergent and post-stabilization services do not require prior authorization. However, notification is required within one business day following the admission date.
Banjo Health integrates seamlessly with Louisiana Medicaid systems, ensuring that PA requests are submitted correctly and decisions are tracked in real-time.
Managed Care Organization (MCO) Specifics
Louisiana's Medicaid program contracts with several MCOs, each with its own PA requirements:
- AmeriHealth Caritas Louisiana: Utilizes Evolent for managing diagnostic imaging services and requires prior authorization for specific procedures.
- Healthy Blue Louisiana: Mandates prior authorization for elective services provided by or arranged at nonparticipating facilities.
- Louisiana Healthcare Connections: Requires standard PA requests to be submitted at least seven business days before the scheduled service delivery date.
Banjo Health can be configured to meet the specific requirements of each MCO, ensuring seamless integration and compliance across different platforms.
Appeals and Continuity of Care
Louisiana regulations stipulate that:
- Continuity of Care: Once a PA is granted, it cannot be retroactively denied unless specific exceptions apply, such as fraud or misinformation.
Banjo Health maintains comprehensive records of all PA decisions and communications, facilitating efficient appeals and ensuring continuity of care for patients.
Why Choose Banjo Health for Louisiana Prior Authorization Compliance
Banjo Health offers a robust solution tailored to Louisiana's PA requirements:
- Automated Workflows: Ensures timely processing of PA requests, reducing administrative burdens.
- Integrated Clinical Criteria: Aligns with LDH policies and supports specialty-matched reviews.
- Real-Time Tracking: Provides transparency and accountability throughout the PA process.
- Comprehensive Reporting: Facilitates compliance with state reporting requirements and supports continuous improvement.
By leveraging Banjo Health, payers and PBMs can navigate Louisiana's PA landscape with confidence and efficiency.
This blog is for informational purposes only and does not constitute legal, regulatory, or professional advice
