Medicaid Managed Care Policies & Procedures Archive (2020)

"Policy or procedure" shall mean a requirement governing the administration of managed care organizations specific to billing guidelines, medical management and utilization review guidelines, case management guidelines, claims processing guidelines and edits, grievance and appeals procedures and process, other guidelines or manuals containing pertinent information related to operations and pre-processing claims, and core benefits and services.

Below are items previously posted for public comment:

Item Number	Policy/Procedure	Date Posted	Comment Period Closed	Status	Document Links
2020-PHARM-257	Thrombopoietin Agents PDL	11/16/20	12/31/20	Approved	Thrombopoietin Agents PDL
2020-PHARM-256	Sickle Cell Anemia PDL	11/16/20	12/31/20	Approved	Sickle Cell Anemia PDL
2020-PHARM-255	PPIs	11/16/20	12/31/20	Approved	PPIs
2020-PHARM-254	POS P and T January 2021 Posting	11/16/20	12/31/20	Approved	POS P and T January 2021 Posting
2020-PHARM-253	POS Thrombopoiesis Stimulating Proteins	11/16/20	12/31/20	Approved	POS Thrombopoiesis Stimulating Proteins
2020-PHARM-252	POS Sickle Cell Anemia Treatments	11/16/20	12/31/20	Approved	POS Sickle Cell Anemia Treatments
2020-PHARM-251	POS Movement Disorders VMAT2 Inhibitors	11/16/20	12/31/20	Approved	POS Movement Disorders VMAT2 Inhibitors
2020-PHARM-250	POS Methotrexate	11/16/20	12/31/20	Approved	POS Methotrexate
2020-PHARM-249	POS Immunomodulators Asthma	11/16/20	12/31/20	Approved	POS Immunomodulators Asthma
2020-PHARM-248	POS Immune Globulins	11/16/20	12/31/20	Approved	POS Immune Globulins
2020-PHARM-247	POS Idiopathic Pulmonary Fibrosis	11/16/20	12/31/20	Approved	POS Idiopathic Pulmonary Fibrosis
2020-PHARM-246	POS Enzyme Replacements	11/16/20	12/31/20	Approved	POS Enzyme Replacements
2020-PHARM-245	POS Botulinum Toxins	11/16/20	12/31/20	Approved	POS Botulinum Toxins
2020-PHARM-244	POS Antipsychotic Agents Oral	11/16/20	12/31/20	Approved	POS Antipsychotic Agents Oral
2020-PHARM-243	POS Anticonvulsants	11/16/20	12/31/20	Approved	POS Anticonvulsants
2020-PHARM-242	POS Anti-Allergens Oral	11/16/20	12/31/20	Approved	POS Anti-Allergens Oral
2020-PHARM-241	POS Anthelmintics	11/16/20	12/31/20	Approved	POS Anthelmintics
2020-PHARM-240	PDL 1.1.21	11/16/20	12/31/20	Approved	PDL 1.1.21
2020-PHARM-239	Otic Agents Antibiotics	11/16/20	12/31/20	Approved	Otic Agents Antibiotics
2020-PHARM-238	Ophthalmic Disorders Glaucoma Agents Intraocular Pressure Reducers	11/16/20	12/31/20	Approved	Ophthalmic Disorders Glaucoma Agents Intraocular Pressure Reducers
2020-PHARM-237	Oncology Agents Oral Renal Cell	11/16/20	12/31/20	Approved	Oncology Agents Oral Renal Cell
2020-PHARM-236	Movement Disorders VMAT2 Inhibitors	11/16/20	12/31/20	Approved	Movement Disorders VMAT2 Inhibitors
2020-PHARM-235	Methotrexate	11/16/20	12/31/20	Approved	Methotrexate
2020-PHARM-234	Immunomodulators Asthma	11/16/20	12/31/20	Approved	Immunomodulators Asthma
2020-PHARM-233	Immune Globulin	11/16/20	12/31/20	Approved	Immune Globulin
2020-PHARM-232	Idiopathic Pulmonary Fibrosis	11/16/20	12/31/20	Approved	Idiopathic Pulmonary Fibrosis
2020-PHARM-231	Enzyme Replacement Agents Gaucher's Disease	11/16/20	12/31/20	Approved	Enzyme Replacement Agents Gaucher's Disease
2020-PHARM-230	Dermatology-Atopic Dermatitis Immunomodulators	11/16/20	12/31/20	Approved	Dermatology-Atopic Dermatitis Immunomodulators
2020-PHARM-229	Botulinum Toxins	11/16/20	12/31/20	Approved	Botulinum Toxins
2020-PHARM-228	Asthma-COPD Inhaled Glucocorticoids	11/16/20	12/31/20	Approved	Asthma-COPD Inhaled Glucocorticoids
2020-PHARM-227	Anticonvulsants	11/16/20	12/31/20	Approved	Anticonvulsants
2020-PHARM-226	Anthelmintics	11/16/20	12/31/20	Approved	Anthelmintics
2020-PHARM-225	Allergen Extracts Oralair Palforzia	11/16/20	12/31/20	Approved	Allergen Extracts Oralair Palforzia
2020-PHARM-224	ADHD	11/16/20	12/31/20	Approved	ADHD
2020-HB-PHARM-25	Testosterone Injectables	11/12/20	12/27/20	Approved	Testosterone Injectables
2020-HB-PHARM-24	Tegsedi	11/12/20	12/27/20	Approved	Tegsedi
2020-HB-PHARM-23	Somatuline Depot	11/12/20	12/27/20	Approved	Somatuline Depot
2020-HB-PHARM-22	Selected GnRH Analogs	11/12/20	12/27/20	Approved	Selected GnRH Analogs
2020-HB-PHARM-21	Polivy	11/12/20	12/27/20	Approved	Polivy
2020-HB-PHARM-20	Onpattro	11/12/20	12/27/20	Approved	Onpattro
2020-HB-PHARM-19	Ocrevus	11/12/20	12/27/20	Approved	Ocrevus
2020-HB-PHARM-18	Lumoxiti	11/12/20	12/27/20	Approved	Lumoxiti
2020-HB-PHARM-17	Lumizyme	11/12/20	12/27/20	Approved	Lumizyme
2020-HB-PHARM-16	Libtayo	11/12/20	12/27/20	Approved	Libtayo
2020-HB-PHARM-15	Jevtana	11/12/20	12/27/20	Approved	Jevtana
2020-HB-PHARM-14	Implantable &ER Buprenorphine Products	11/12/20	12/27/20	Approved	Implantable &ER Buprenorphine Products
2020-HB-PHARM-13	Fabrazyme	11/12/20	12/27/20	Approved	Fabrazyme
2020-HB-PHARM-12	Evenity	11/12/20	12/27/20	Approved	Evenity
2020-HB-PHARM-11	Erythropoiesis Stimulating Agents	11/12/20	12/27/20	Approved	Erythropoiesis Stimulating Agents
2020-HB-PHARM-10	ERT for Gaucher’s Disease	11/12/20	12/27/20	Approved	ERT for Gaucher’s Disease
2020-HB-PHARM-9	Denosumab Agents	11/12/20	12/27/20	Approved	Denosumab Agents
2020-HB-PHARM-8	Brineura	11/12/20	12/27/20	Approved	Brineura
2020-HB-PHARM-7	Beta Interferons & Glatiramer Acetate	11/12/20	12/27/20	Approved	Beta Interferons & Glatiramer Acetate
2020-HB-PHARM-6	Benlysta	11/12/20	12/27/20	Approved	Benlysta
2020-HB-PHARM-5.0	Alpha-1 Proteinase Inhibitor Therapy	11/12/20	12/27/20	Approved	Alpha-1 Proteinase Inhibitor Therapy
2020-ACLA-PHARM-5	Diabetic Testing Supplies	11/12/20	12/27/20	Approved	Diabetic Testing Supplies
2020-ACLA-818	Prior Authorizations Update	11/18/20	1/2/21	Complete	Prior Authorizations Update
2020-LDH-1	LDH MCO Manual	11/10/20	12/25/20	Approved	LDH MCO Manual
2020-HB-PHARM-5	Avsola Medical Step Therapy	11/4/20	12/18/20	Approved	Avsola Medical Step Therapy
2020-LHCC-PHARM-4	Requests for Pharmacy Profiles	10/30/20	12/13/20	Approved	Requests for Pharmacy Profiles
2020-LHCC-PHARM-3	PBM Inquiry for Additional Information	10/30/20	12/13/20	Approved	PBM Inquiry for Additional Information
2020-LHCC-PHARM-2	Drug Utilization	10/30/20	12/13/20	Approved	Drug Utilization
2020-HB-PHARM-4	Anti VEGF Medical Step Therapy	10/27/20	12/10/20	Approved	Anti VEGF Medical Step Therapy
2020-HB-PHARM-3	Herceptin Bio Med Step Therapy	10/26/20	12/9/20	Approved	Herceptin Bio Med Step Therapy
2020-PHARM-223	Uterine Disorder Treatment	10/26/20	12/9/20	Approved	Uterine Disorder Treatment
2020-PHARM-222	Urology Incontinence Bladder Relaxant Preparations	10/26/20	12/9/20	Approved	Urology Incontinence Bladder Relaxant Preparations
2020-PHARM-221	Smoking Cessation Products	10/26/20	12/9/20	Approved	Smoking Cessation Products
2020-PHARM-220	Sinus Node Inhibitors	10/26/20	12/9/20	Approved	Sinus Node Inhibitors
2020-PHARM-219	Prostate Benign Prostatic Hyperplasia Treatment	10/26/20	12/9/20	Approved	Prostate Benign Prostatic Hyperplasia Treatment
2020-PHARM-218	Progestational Agents	10/26/20	12/9/20	Approved	Progestational Agents
2020-PHARM-217	Pituitary Suppressive Agents	10/26/20	12/9/20	Approved	Pituitary Suppressive Agents
2020-PHARM-216	Pediatric Multivitamins	10/26/20	12/9/20	Approved	Pediatric Multivitamins
2020-PHARM-215	Parkinsons Antiparkinson Agents Anticholinergic and Other	10/26/20	12/9/20	Approved	Parkinsons Antiparkinson Agents Anticholinergic and Other
2020-PHARM-214	Pain Management Skeletal Muscle Relaxants	10/26/20	12/9/20	Approved	Pain Management Skeletal Muscle Relaxants
2020-PHARM-213	Pain Management Neuropathic Pain	10/26/20	12/9/20	Approved	Pain Management Neuropathic Pain
2020-PHARM-212	Pain Management Narcotic Analgesics Short Acting	10/26/20	12/9/20	Approved	Pain Management Narcotic Analgesics Short Acting
2020-PHARM-211	Pain Management Narcotic Analgesics Long Acting	10/26/20	12/9/20	Approved	Pain Management Narcotic Analgesics Long Acting
2020-PHARM-210	Pain Management Cytokine and CAM Antagonists	10/26/20	12/9/20	Approved	Pain Management Cytokine and CAM Antagonists
2020-PHARM-209	Pain Management Antimigraine Agents Triptans	10/26/20	12/9/20	Approved	Pain Management Antimigraine Agents Triptans
2020-PHARM-208	Pain Management Antimigraine Agents Ergotamine	10/26/20	12/9/20	Approved	Pain Management Antimigraine Agents Ergotamine
2020-PHARM-207	Pain Management Antimigraine Agents CGRP Antagonists	10/26/20	12/9/20	Approved	Pain Management Antimigraine Agents CGRP Antagonists
2020-PHARM-206	Otic Agents Anti Infectives and Anesthetics	10/26/20	12/9/20	Approved	Otic Agents Anti Infectives and Anesthetics
2020-PHARM-205	Osteoporosis Bone Resorption Suppression Agents	10/26/20	12/9/20	Approved	Osteoporosis Bone Resorption Suppression Agents
2020-PHARM-204	Opiate Dependence Agents	10/26/20	12/9/20	Approved	Opiate Dependence Agents
2020-PHARM-203	Ophthalmic Disorders Glaucoma Agents Intraocular Pressure Reducers	10/26/20	12/9/20	Approved	Ophthalmic Disorders Glaucoma Agents Intraocular Pressure Reducers
2020-PHARM-202	Ophthalmic Disorders Anti-Inflammatory Immunomodulators	10/26/20	12/9/20	Approved	Ophthalmic Disorders Anti-Inflammatory Immunomodulators
2020-PHARM-201	Ophthalmic Disorders Anti-Inflammatories	10/26/20	12/9/20	Approved	Ophthalmic Disorders Anti-Inflammatories
2020-PHARM-200	Ophthalmic Disorders Antibiotic-Steroid Combinations	10/26/20	12/9/20	Approved	Ophthalmic Disorders Antibiotic-Steroid Combinations
2020-PHARM-199	Ophthalmic Disorders Allergic Conjunctivitis	10/26/20	12/9/20	Approved	Ophthalmic Disorders Allergic Conjunctivitis
2020-PHARM-198	Oncology Oral Skin	10/26/20	12/9/20	Approved	Oncology Oral Skin
2020-PHARM-197	Oncology Oral Renal Cell	10/26/20	12/9/20	Approved	Oncology Oral Renal Cell
2020-PHARM-196	Oncology Oral Prostate	10/26/20	12/9/20	Approved	Oncology Oral Prostate
2020-PHARM-195	Oncology Oral Other	10/26/20	12/9/20	Approved	Oncology Oral Other
2020-PHARM-194	Oncology Oral Lung	10/26/20	12/9/20	Approved	Oncology Oral Lung
2020-PHARM-193	Oncology Oral Hematologic	10/26/20	12/9/20	Approved	Oncology Oral Hematologic
2020-PHARM-192	Oncology Oral Breast	10/26/20	12/9/20	Approved	Oncology Oral Breast
2020-PHARM-191	Multiple Sclerosis Multiple Sclerosis Agents Immunomodulatory Agents	10/26/20	12/9/20	Approved	Multiple Sclerosis Multiple Sclerosis Agents Immunomodulatory Agents
2020-PHARM-190	Infectious Disorders Hepatitis C Agents Not Direct Acting Antiviral Agents	10/26/20	12/9/20	Approved	Infectious Disorders Hepatitis C Agents Not Direct Acting Antiviral Agents
2020-PHARM-189	Infectious Disorders Hepatitis C Agents Direct Acting Antiviral Agents	10/26/20	12/9/20	Approved	Infectious Disorders Hepatitis C Agents Direct Acting Antiviral Agents
2020-PHARM-188	Infectious Disorders Antibiotics Vaginal	10/26/20	12/9/20	Approved	Infectious Disorders Antibiotics Vaginal
2020-PHARM-187	Infectious Disorders Antibiotics Streptogramins	10/26/20	12/9/20	Approved	Infectious Disorders Antibiotics Streptogramins
2020-PHARM-186	Infectious Disorders Antibiotics Oxazolidinones	10/26/20	12/9/20	Approved	Infectious Disorders Antibiotics Oxazolidinones
2020-PHARM-185	Infectious Disorders Antibiotics Nitrofuran Derivatives	10/26/20	12/9/20	Approved	Infectious Disorders Antibiotics Nitrofuran Derivatives
2020-PHARM-184	Infectious Disorders Antibiotics Macrolides Ketolides	10/26/20	12/9/20	Approved	Infectious Disorders Antibiotics Macrolides Ketolides
2020-PHARM-183	Infectious Disorders Antibiotics Lincosamides	10/26/20	12/9/20	Approved	Infectious Disorders Antibiotics Lincosamides
2020-PHARM-182	Infectious Disorders Antibiotics Inhaled Antibiotics	10/26/20	12/9/20	Approved	Infectious Disorders Antibiotics Inhaled Antibiotics
2020-PHARM-181	Infectious Disorders Antibiotics Gastrointestinal Antibiotics	10/26/20	12/9/20	Approved	Infectious Disorders Antibiotics Gastrointestinal Antibiotics
2020-PHARM-180	Infectious Disorders Antibiotics Fluoroquinolones	10/26/20	12/9/20	Approved	Infectious Disorders Antibiotics Fluoroquinolones
2020-PHARM-179	Immunosuppressives Oral	10/26/20	12/9/20	Approved	Immunosuppressives Oral
2020-PHARM-178	Hemodialysis Phosphate Binders	10/26/20	12/9/20	Approved	Hemodialysis Phosphate Binders
2020-PHARM-177	Hematologic Agents Hematopoietic Agents Erythropoietins	10/26/20	12/9/20	Approved	Hematologic Agents Hematopoietic Agents Erythropoietins
2020-PHARM-176	Heart Disease Hyperlipidemia Vasodilators Coronary	10/26/20	12/9/20	Approved	Heart Disease Hyperlipidemia Vasodilators Coronary
2020-PHARM-175	Heart Disease Hyperlipidemia Sympatholytics	10/26/20	12/9/20	Approved	Heart Disease Hyperlipidemia Sympatholytics
2020-PHARM-174	Heart Disease Hyperlipidemia Statins and Statin Combination Agents	10/26/20	12/9/20	Approved	Heart Disease Hyperlipidemia Statins and Statin Combination Agents
2020-PHARM-173	Heart Disease Hyperlipidemia Pulmonary Arterial Hypertension	10/26/20	12/9/20	Approved	Heart Disease Hyperlipidemia Pulmonary Arterial Hypertension
2020-PHARM-172	Heart Disease Hyperlipidemia Lipotropics Other	10/26/20	12/9/20	Approved	Heart Disease Hyperlipidemia Lipotropics Other
2020-PHARM-171	Heart Disease Hyperlipidemia Hypertension Calcium Channel Blockers	10/26/20	12/9/20	Approved	Heart Disease Hyperlipidemia Hypertension Calcium Channel Blockers
2020-PHARM-170	Heart Disease Hyperlipidemia Hypertension Beta Blocker Agents	10/26/20	12/9/20	Approved	Heart Disease Hyperlipidemia Hypertension Beta Blocker Agents
2020-PHARM-169	Heart Disease Hyperlipidemia Hypertension Angiotensin Modulators Calcium Channel Blockers Combinations	10/26/20	12/9/20	Approved	Heart Disease Hyperlipidemia Hypertension Angiotensin Modulators Calcium Channel Blockers Combinations
2020-PHARM-168	Heart Disease Hyperlipidemia Hypertension ACE Inhibitors and Direct Renin Inhibitors	10/26/20	12/9/20	Approved	Heart Disease Hyperlipidemia Hypertension ACE Inhibitors and Direct Renin Inhibitors
2020-PHARM-167	Heart Disease Hyperlipidemia Anticoagulants Platelet Aggregation Inhibitors	10/23/20	12/6/20	Pending	Heart Disease Hyperlipidemia Anticoagulants Platelet Aggregation Inhibitors
2020-PHARM-166	Heart Disease Hyperlipidemia Anticoagulants	10/23/20	12/6/20	Pending	Heart Disease Hyperlipidemia Anticoagulants
2020-PHARM-165	H Pylori Treatment	10/23/20	12/6/20	Pending	H Pylori Treatment
2020-PHARM-164	Growth Deficiency Growth Hormones	10/23/20	12/6/20	Pending	Growth Deficiency Growth Hormones
2020-PHARM-163	Gout Agents Antihyperuricemics	10/23/20	12/6/20	Pending	Gout Agents Antihyperuricemics
2020-PHARM-162	Glucocorticoids Oral	10/23/20	12/6/20	Pending	Glucocorticoids Oral
2020-PHARM-161	GI Motility Chronic	10/23/20	12/6/20	Pending	GI Motility Chronic
2020-PHARM-160	Epinephrine Self Injected	10/23/20	12/6/20	Pending	Epinephrine Self Injected
2020-PHARM-159	Digestive Disorders Ulcerative Colitis Agents	10/23/20	12/6/20	Pending	Digestive Disorders Ulcerative Colitis Agents
2020-PHARM-158	Digestive Disorders Proton Pump Inhibitors	10/23/20	12/6/20	Pending	Digestive Disorders Proton Pump Inhibitors
2020-PHARM-157	Digestive Disorders Pancreatic Enzymes	10/23/20	12/6/20	Pending	Digestive Disorders Pancreatic Enzymes
2020-PHARM-156	Digestive Disorders Histamine II Receptor Blockers	10/23/20	12/6/20	Pending	Digestive Disorders Histamine II Receptor Blockers
2020-PHARM-155	Digestive Disorders Bile Acid Salts	10/23/20	12/6/20	Pending	Digestive Disorders Bile Acid Salts
2020-PHARM-154	Digestive Disorders Antiemetic Antivertigo Agents	10/23/20	12/6/20	Pending	Digestive Disorders Antiemetic Antivertigo Agents
2020-PHARM-153	Diabetes Metformins	10/23/20	12/6/20	Pending	Diabetes Metformins
2020-PHARM-152	Diabetes Hypoglycemics Thiazolidinediones	10/23/20	12/6/20	Pending	Diabetes Hypoglycemics Thiazolidinediones
2020-PHARM-151	Diabetes Hypoglycemics Sulfonylureas	10/23/20	12/6/20	Pending	Diabetes Hypoglycemics Sulfonylureas
2020-PHARM-150	Diabetes Hypoglycemics Sodium Glucose Co Transporter 2 Inhibitors	10/23/20	12/6/20	Pending	Diabetes Hypoglycemics Sodium Glucose Co Transporter 2 Inhibitors
2020-PHARM-149	Diabetes Hypoglycemics Meglitinides	10/23/20	12/6/20	Pending	Diabetes Hypoglycemics Meglitinides
2020-PHARM-148	Diabetes Hypoglycemics Insulins and Related Agents	10/23/20	12/6/20	Pending	Diabetes Hypoglycemics Insulins and Related Agents
2020-PHARM-147	Diabetes Hypoglycemics Incretin Mimetics Enhancers	10/23/20	12/6/20	Pending	Diabetes Hypoglycemics Incretin Mimetics Enhancers
2020-PHARM-146	Diabetes Alpha Glucosidase Inhibitors	10/23/20	12/6/20	Pending	Diabetes Alpha Glucosidase Inhibitors
2020-PHARM-145	Dermatology Steroids Topical Medium Potency	10/23/20	12/6/20	Pending	Dermatology Steroids Topical Medium Potency
2020-PHARM-144	Dermatology Steroids Topical Low Potency	10/23/20	12/6/20	Pending	Dermatology Steroids Topical Low Potency
2020-PHARM-143	Dermatology Steroids Topical High Potency	10/23/20	12/6/20	Pending	Dermatology Steroids Topical High Potency
2020-PHARM-142	Dermatology Immunomodulators Topical	10/23/20	12/6/20	Pending	Dermatology Immunomodulators Topical
2020-PHARM-141	Dermatology Emollients	10/23/20	12/6/20	Pending	Dermatology Emollients
2020-PHARM-140	Dermatology Atopic Dermatitis Immunomodulators	10/23/20	12/6/20	Pending	Dermatology Atopic Dermatitis Immunomodulators
2020-PHARM-139	Dermatology Antiviral Agents Topical	10/23/20	12/6/20	Pending	Dermatology Antiviral Agents Topical
2020-PHARM-138	Dermatology Antipsoriatics Topical	10/23/20	12/6/20	Pending	Dermatology Antipsoriatics Topical
2020-PHARM-137	Dermatology Antipsoriatics Oral	10/23/20	12/6/20	Pending	Dermatology Antipsoriatics Oral
2020-PHARM-136	Dermatology Antiparasitic Agents Topical	10/23/20	12/6/20	Pending	Dermatology Antiparasitic Agents Topical
2020-PHARM-135	Cystic Fibrosis Oral	10/23/20	12/6/20	Pending	Cystic Fibrosis Oral
2020-PHARM-134	Colony Stimulating Factors	10/23/20	12/6/20	Pending	Colony Stimulating Factors
2020-PHARM-133	Asthma COPD Leukotriene Modifiers	10/23/20	12/6/20	Pending	Asthma COPD Leukotriene Modifiers
2020-PHARM-132	Asthma COPD Glucocorticoids Inhalation	10/22/20	12/5/20	Approved	Asthma COPD Glucocorticoids Inhalation
2020-PHARM-131	Asthma COPD Bronchodilator Beta Adrenergic Oral Agents	10/22/20	12/5/20	Approved	Asthma COPD Bronchodilator Beta Adrenergic Oral Agents
2020-PHARM-130	Asthma COPD Bronchodilator Beta Adrenergic Inhalation Agents	10/22/20	12/5/20	Approved	Asthma COPD Bronchodilator Beta Adrenergic Inhalation Agents
2020-PHARM-129	Asthma COPD Bronchodilator Anticholinergics COPD Oral	10/22/20	12/5/20	Approved	Asthma COPD Bronchodilator Anticholinergics COPD Oral
2020-PHARM-128	Asthma COPD Bronchodilator Anticholinergics COPD Inhalation	10/22/20	12/5/20	Approved	Asthma COPD Bronchodilator Anticholinergics COPD Inhalation
2020-PHARM-127	Antivirals Oral	10/22/20	12/5/20	Approved	Antivirals Oral
2020-PHARM-126	Androgenic Agents	10/22/20	12/5/20	Approved	Androgenic Agents
2020-PHARM-125	Alzheimers Agents	10/22/20	12/5/20	Approved	Alzheimers Agents
2020-PHARM-124	Allergy Rhinitis Agents Nasal	10/22/20	12/5/20	Approved	Allergy Rhinitis Agents Nasal
2020-PHARM-123	Allergy Antihistamines Minimally Sedating	10/22/20	12/5/20	Approved	Allergy Antihistamines Minimally Sedating
2020-PHARM-122	Vyondys	10/22/20	12/5/20	Approved	Vyondys
2020-PHARM-121	Spinraza Form	10/22/20	12/5/20	Approved	Spinraza Form
2020-PHARM-120	Spinraza Criteria	10/22/20	12/5/20	Approved	Spinraza Criteria
2020-PHARM-119	Selected Anti Infective Anti Fungal and Corticosteroid Quantity Limits Plus Criteria	10/22/20	12/5/20	Approved	Selected Anti Infective Anti Fungal and Corticosteroid Quantity Limits Plus Criteria
2020-PHARM-118	POS DUR January 2021 Posting Revised	10/22/20	12/5/20	Approved	POS DUR January 2021 Posting Revised
2020-PHARM-117	POS Sedative Hypnotics	10/22/20	12/5/20	Approved	POS Sedative Hypnotics
2020-PHARM-116	POS Pain Management Nonsteroidal Anti Inflammatory Drugs	10/22/20	12/5/20	Approved	POS Pain Management Nonsteroidal Anti Inflammatory Drugs
2020-PHARM-115	POS Otic Agents Antibiotics	10/22/20	12/5/20	Approved	POS Otic Agents Antibiotics
2020-PHARM-114	POS Opthalmic Disorders Antibiotics	10/22/20	12/5/20	Approved	POS Opthalmic Disorders Antibiotics
2020-PHARM-113	POS Infectious Disorders Antifungals Oral	10/22/20	12/5/20	Approved	POS Infectious Disorders Antifungals Oral
2020-PHARM-112	POS Infectious Disorders Antibiotics Tetracyclines	10/22/20	12/5/20	Approved	POS Infectious Disorders Antibiotics Tetracyclines
2020-PHARM-111	POS Infectious Disorders Antibiotics Cephalosporin and Related Antibiotics	10/22/20	12/5/20	Approved	POS Infectious Disorders Antibiotics Cephalosporin and Related Antibiotics
2020-PHARM-110	POS Hemophilia Treatment	10/22/20	12/5/20	Approved	POS Hemophilia Treatment
2020-PHARM-109	POS Document for October DUR	10/22/20	12/5/20	Approved	POS Document for October DUR
2020-PHARM-108	POS Dermatology Steriods Topical Very High Potency	10/22/20	12/5/20	Approved	POS Dermatology Steriods Topical Very High Potency
2020-PHARM-107	POS Dermatology Antifungals Topical	10/22/20	12/5/20	Approved	POS Dermatology Antifungals Topical
2020-PHARM-106	POS Dermatology Antibiotics Topical	10/22/20	12/5/20	Approved	POS Dermatology Antibiotics Topical
2020-PHARM-105	POS Depression Selective Serotonin Reuptake Inhibitors	10/22/20	12/5/20	Approved	POS Depression Selective Serotonin Reuptake Inhibitors
2020-PHARM-104	POS Depression Antidepressants Other	10/22/20	12/5/20	Approved	POS Depression Antidepressants Other
2020-PHARM-103	POS Anxiolytics	10/22/20	12/5/20	Approved	POS Anxiolytics
2020-PHARM-102	POS Antipsychotic Agents Oral	10/22/20	12/5/20	Approved	POS Antipsychotic Agents Oral
2020-PHARM-101	POS Antipsychotic Agents Injectable Agents	10/22/20	12/5/20	Approved	POS Antipsychotic Agents Injectable Agents
2020-PHARM-100	POS ADD-ADHD Stimulants and Related Agents	10/22/20	12/5/20	Approved	POS ADD-ADHD Stimulants and Related Agents
2020-PHARM-99	POS Acne Agents	10/22/20	12/5/20	Approved	POS Acne Agents
2020-PHARM-98	PDL 7-1-20 for 10-7-20 Diabetic Supplies	10/22/20	12/5/20	Approved	PDL 7-1-20 for 10-7-20 Diabetic Supplies
2020-PHARM-97	Pain Management Non Steriodal AntiInflammatory Agents	10/22/20	12/5/20	Approved	Pain Management Non Steriodal AntiInflammatory Agents
2020-PHARM-96	Other Behavioral Health Under 7	10/22/20	12/5/20	Approved	Other Behavioral Health Under 7
2020-PHARM-95	Nocdurna POS	10/22/20	12/5/20	Approved	Nocdurna POS
2020-PHARM-94	Medically Necessary Criteria	10/22/20	12/5/20	Approved	Medically Necessary Criteria
2020-PHARM-93	Louisiana Medicaid ICD-10 Chart with October DUR Updates redline	10/22/20	12/5/20	Approved	Louisiana Medicaid ICD-10 Chart with October DUR Updates redline
2020-PHARM-92	Immune Globulin Criteria	10/22/20	12/5/20	Approved	Immune Globulin Criteria
2020-PHARM-91	Exondys	10/22/20	12/5/20	Approved	Exondys
2020-PHARM-90	Evrysdi	10/22/20	12/5/20	Approved	Evrysdi
2020-PHARM-89	Epidiolex Criteria	10/22/20	12/5/20	Approved	Epidiolex Criteria
2020-PHARM-88	Enzyme Replacement Therapy Diagnosis Code and TD Edits	10/22/20	12/5/20	Approved	Enzyme Replacement Therapy Diagnosis Code and TD Edits
2020-PHARM-87	Diabetes Strips Lancets Quantity Limit	10/22/20	12/5/20	Approved	Diabetes Strips Lancets Quantity Limit
2020-PHARM-86	Depression Antidepressants SSRIs	10/22/20	12/5/20	Approved	Depression Antidepressants SSRIs
2020-PHARM-85	Depression Antidepressants Other	10/22/20	12/5/20	Approved	Depression Antidepressants Other
2020-PHARM-84	Cytokine and CAM Antagonists	10/22/20	12/5/20	Approved	Cytokine and CAM Antagonists
2020-PHARM-83	Botulinum Toxins Diagnosis Code and Quantity Limits	10/22/20	12/5/20	Approved	Botulinum Toxins Diagnosis Code and Quantity Limits
2020-PHARM-82	Anxiolytics	10/22/20	12/5/20	Approved	Anxiolytics
2020-PHARM-81	Antipsychotics	10/22/20	12/5/20	Approved	Antipsychotics
2020-PHARM-80	Allergen Extracts	10/22/20	12/5/20	Approved	Allergen Extracts
2020-PHARM-79	ADHD	10/22/20	12/5/20	Approved	ADHD
2020-HB-PHARM-2	Avastin Biosimilars Sed Step Therapy Notice	10/22/20	12/5/20	Approved	Avastin Biosimilars Sed Step Therapy Notice
2020-UHC-PHARM-26	Benlysta	10/21/20	12/4/20	Approved	Benlysta
2020-UHC-PHARM-25	Trogarzo	10/21/20	12/4/20	Approved	Trogarzo
2020-UHC-PHARM-24	Testosterone	10/21/20	12/4/20	Approved	Testosterone
2020-UHC-PHARM-23	Radicava	10/16/20	11/30/20	Approved	Radicava
2020-UHC-PHARM-22	Reblozyl	10/16/20	11/30/20	Approved	Reblozyl
2020-UHC-PHARM-21	Parsabiv	10/16/20	11/30/20	Approved	Parsabiv
2020-UHC-PHARM-20	Immune Globulins	10/16/20	11/30/20	Approved	Immune Globulins
2020-UHC-PHARM-19	Botulinum Toxins	10/16/20	11/30/20	Approved	Botulinum Toxins
2020-UHC-PHARM-18	Rituxan	10/16/20	11/30/20	Approved	Rituxan
2020-UHC-PHARM-17	Somatostatin Analogs	10/16/20	11/30/20	Approved	Somatostatin Analogs
2020-UHC-PHARM-16	Buprenorphine	10/16/20	11/30/20	Approved	Buprenorphine
2020-UHC-PHARM-15	Gaucher Disease	10/13/20	11/27/20	Approved	Gaucher Disease
2020-UHC-PHARM-14	Vyepti	10/13/20	11/27/20	Approved	Vyepti
2020-UHC-PHARM-13	Enzyme Replacement Therapy	10/13/20	11/27/20	Approved	Enzyme Replacement Therapy
2020-UHC-PHARM-12	Tepezza	10/13/20	11/27/20	Approved	Tepezza
2020-UHC-PHARM-11	Onpattro	10/13/20	11/27/20	Approved	Onpattro
2020-UHC-PHARM-10	Complement Inhibitors	10/13/20	11/27/20	Approved	Complement Inhibitors
2020-UHC-PHARM-9	IV Iron Replacement Therapy	10/13/20	11/27/20	Approved	IV Iron Replacement Therapy
2020-UHC-PHARM-8	Denosumab	10/13/20	11/27/20	Approved	Denosumab
2020-UHC-PHARM-7	Brineura	10/13/20	11/27/20	Approved	Brineura
2020-UHC-PHARM-6	Crysvita	10/13/20	11/27/20	Approved	Crysvita
2020-UHC-PHARM-5	Krystexxa	10/13/20	11/27/20	Approved	Krystexxa
2020-UHC-PHARM-4	Sodium Hyaluronate	10/13/20	11/27/20	Approved	Sodium Hyaluronate
2020-LHCC-PHARM-1	Pharmacy Prior Authorization and Medical Necessity	9/30/20	11/14/20	Approved	Pharmacy Prior Authorization and Medical Necessity
2020-UHC-PHARM-1	Scenesse	9/28/20	11/12/20	Approved	Scenesse
2020-UHC-PHARM-2	Uplizna	9/28/20	11/12/20	Approved	Uplizna
2020-UHC-PHARM-3	Viltepso	9/28/20	11/12/20	Approved	Viltepso
2020-ACLA-PHARM-4	Specialty Drugs PA Criteria	9/15/20	10/30/20	Approved	Specialty Drugs PA Criteria
2020-ACLA-PHARM-3	Oncology Drugs PA Criteria	9/8/20	10/24/20	Approved	Oncology Drugs PA Criteria
2020-ACLA-PHARM-1	Remdesivir	9/1/20	10/16/20	Approved	Remdesivir
2020-ACLA-PHARM-2	Diabetic Testing Supplies	9/1/20	10/16/20	Approved	Diabetic Testing Supplies
2020-LHCC-814	Crisis Intervention Policy	8/28/20	10/12/20	Approved	Crisis Intervention Policy
2020-LHCC-817	Vitamin D Testing Policy	8/28/20	10/12/20	Approved	Vitamin D Testing Policy
2020-ABH-PHARM-2	Compounds	8/25/20	10/9/20	Complete	Compounds
2020-ABH-PHARM-1	Quantity Level Limit	8/19/20	10/3/20	Approved	Quantity Level Limit
2020-HBL-816	Vitamin D Policy	8/18/20	10/2/20	Approved	Vitamin D Policy
2020-ACLA-815	Vitamin D Policy	8/14/20	9/28/20	Approved	Vitamin D Policy
2020-ABH-813	Vitamin D Policy	8/14/20	9/28/20	Approved	Vitamin D Policy
2020-HPA-3	HPA: Tobacco Cessation for Pregnant Women	8/11/20	9/25/20	Complete	HPA: Tobacco Cessation for Pregnant Women
2020-IB-2	IB: Tobacco Cessation for Pregnant Women	8/11/20	9/25/20	Complete	IB: Tobacco Cessation for Pregnant Women
2020-UHC-812	Vitamin D Policy	8/7/20	9/21/20	Approved	Vitamin D Policy
2020-SCG-3	Tracking of Evidence Based Practices (EBP)	8/6/20	9/20/20	Complete	MCO SCG July 2020 pg. 16-17
2020-PHARM-78	Asthma COPD Bronchodilator Anticholinergics Inhalation	7/31/20	9/14/20	Approved	Asthma COPD Bronchodilator Anticholinergics Inhalation
2020-PHARM-77	Cytokineand CAM Antagonists	7/31/20	9/14/20	Approved	Cytokineand CAM Antagonists
2020-PHARM-76	Dermatology Atopic Dermatitis Immunomodulators	7/31/20	9/14/20	Approved	Dermatology Atopic Dermatitis Immunomodulators
2020-PHARM-75	Diabetes Hypoglycemics Incretin Mimetics Enhancers	7/31/20	9/14/20	Approved	Diabetes Hypoglycemics Incretin Mimetics Enhancers
2020-PHARM-74	Esbriet	7/31/20	9/14/20	Approved	Esbriet
2020-PHARM-73	Fetroja	7/31/20	9/14/20	Approved	Fetroja
2020-PHARM-72	Givlaari	7/31/20	9/14/20	Approved	Givlaari
2020-PHARM-71	Hepatitis C DAA	7/31/20	9/14/20	Approved	Hepatitis C DAA
2020-PHARM-70	Infectious Disorders Hepatitis C Agents Direct Acting Antiviral Agents	7/31/20	9/14/20	Approved	Infectious Disorders Hepatitis C Agents Direct Acting Antiviral Agents
2020-PHARM-69	Koselugo	7/31/20	9/14/20	Approved	Koselugo
2020-PHARM-68	Ofev	7/31/20	9/14/20	Approved	Ofev
2020-PHARM-67	Oxbryta	7/31/20	9/14/20	Approved	Oxbryta
2020-PHARM-66	POS DUR October 2020	7/31/20	9/14/20	Approved	POS DUR October 2020
2020-PHARM-65	Sedative Hypnotics	7/31/20	9/14/20	Approved	Sedative Hypnotics
2020-PHARM-64	Tikosyn	7/31/20	9/14/20	Approved	Tikosyn
2020-PHARM-63	VMAT2 Inhibitors	7/31/20	9/14/20	Approved	VMAT2 Inhibitors
2020-PHARM-62	Xenleta	7/31/20	9/14/20	Approved	Xenleta
2020-HBL-366	Out-of-Area, Out-of-Network Care	7/24/20	9/7/20	Approved	Out-of-Area, Out-of-Network Care
2020-HBL-542.1 2020-HBL-542.2	Anesthesia Services for Interventional Pain Management Procedures and Clinical Guidelines	7/24/20	9/7/20	Completed	Anesthesia Services for Interventional Pain Management Procedures Clinical Guidelines
2020-UHC-564	Benlysta	7/24/20	9/7/20	Approved	Benlysta
2020-UHC-565	Crysvita	7/24/20	9/7/20	Approved	Crysvita
2020-UHC-567	Maximum Dosage	7/24/20	9/7/20	Approved	Maximum Dosage
2020-UHC-568	Ocrevus	7/24/20	9/7/20	Approved	Ocrevus
2020-UHC-569	Off Label Unproven	7/24/20	9/7/20	Approved	Off Label Unproven
2020-UHC-572	Reblozyl	7/24/20	9/7/20	Approved	Reblozyl
2020-UHC-574	Testosterone Replacement	7/24/20	9/7/20	Approved	Testosterone Replacement
2020-LHCC-610	Authorization Error Correction Process	7/24/20	9/7/20	Completed	Authorization Error Correction Process
2020-LHCC-636	Authorization for Second Clinical Opinions	7/24/20	9/7/20	Completed	Authorization for Second Clinical Opinions
2020-LHCC-682	Active Procedures in Physical Medicine	7/24/20	9/7/20	Approved	Active Procedures in Physical Medicine
2020-LHCC-683	Chiro Infant Care Policy	7/24/20	9/7/20	Approved	Chiro Infant Care Policy
2020-LHCC-684	Chiro Infant Care Policy	7/24/20	9/7/20	Approved	Chiro Infant Care Policy
2020-LHCC-685	Experimental, Unproven, or Investigational Services	7/24/20	9/7/20	Approved	Experimental, Unproven, or Investigational Services
2020-HBL-318	Clinical Information for Utilization Review	7/16/20	8/30/20	Approved	Clinical Information for Utilization Review
2020-HBL-328	Pre-Certification of Requested Services	7/16/20	8/30/20	Approved	Pre-Certification of Requested Services
2020-UHC-535	Nat'l Drug Code (NDC) Requirement Policy	7/16/20	8/30/20	Approved	Nat'l Drug Code (NDC) Requirement Policy
2020-ACLA-538	PCP Assignment	7/16/20	8/30/20	Approved	PCP Assignment
2020-HBL-588	Retrospective Review	7/16/20	8/30/20	Approved	Retrospective Review
2020-LHCC-609	Court Ordered Services Louisiana PP	7/16/20	8/30/20	Approved	Court Ordered Services Louisiana PP
2020-HBL-677	SPOT AIM Rehab Transition Bulletin	7/16/20	8/30/20	Approved	SPOT AIM Rehab Transition Bulletin
2020-HB-PHARM-1	Louisiana Compound Coverage	7/21/20	9/4/20	Approved	Louisiana Compound Coverage
2020-HBL-316	Associates Performing Utilization Review	7/9/20	8/23/20	Approved	Associates Performing Utilization Review
2020-HBL-576	AIM Musculoskeletal Prog Clinical Appropriateness Guidelines	7/9/20	8/23/20	Approved	AIM Musculoskeletal Prog Clinical Appropriateness Guidelines
2020-LHCC-329	Adverse Determinations	7/9/20	8/23/20	Approved	Adverse Determinations
2020-LHCC-429	UM Program Description	7/9/20	8/23/20	Approved	UM Program Description
2020-LHCC-498	Mental Health Rehab MNC Policy	7/9/20	8/23/20	Approved	Mental Health Rehab MNC Policy
2020-LHCC-532	Appropriate UM Professionals	7/9/20	8/23/20	Approved	Appropriate UM Professionals
2020-LHCC-607	Inpatient Leveling of Care WP	7/9/20	8/23/20	Completed	Inpatient Leveling of Care WP
2020-UHC-557	Transcranial Magnetic Stimulation	7/9/20	8/23/20	Approved	Transcranial Magnetic Stimulation
2020-UHC-558	Knee Replacement Surgery (Arthroplasty), Total and Partial	7/9/20	8/23/20	Approved	Knee Replacement Surgery (Arthroplasty), Total and Partial
2020-UHC-559	Implantable Beta-Emitting Microspheres	7/9/20	8/23/20	Approved	Implantable Beta-Emitting Microspheres
2020-UHC-560	Home Hemodialysis	7/9/20	8/23/20	Approved	Home Hemodialysis
2020-UHC-561	Cognitive Rehabilitation	7/9/20	8/23/20	Approved	Cognitive Rehabilitation
2020-HBL-602.1	Medical drug Clinical Criteria updates	7/2/20	8/16/20	Approved	Medical drug Clinical Criteria updates
2020-HBL-602.2	Faslodex Criteria	7/2/20	8/16/20	Approved	Faslodex Criteria
2020-HBL-602.3	Gazyva Criteria	7/2/20	8/16/20	Approved	Gazyva Criteria
2020-HBL-602.4	Immunoglobulins Criteria	7/2/20	8/16/20	Approved	Immunoglobulins Criteria
2020-HBL-602.5	Intravitreal Corticosteroid Implants Criteria	7/2/20	8/16/20	Approved	Intravitreal Corticosteroid Implants Criteria
2020-HBL-602.6	Keytruda Criteria	7/2/20	8/16/20	Approved	Keytruda Criteria
2020-HBL-602.7	Gonadotropin Releasing Hormone Analogs for the Treatment of Non-Oncologic Indications Criteria	7/2/20	8/16/20	Approved	Gonadotropin Releasing Hormone Analogs for the Treatment of Non-Oncologic Indications Criteria
2020-LHCC-505	New Follow-Up After Hospitalization Policy	7/2/20	8/16/20	Approved	New Follow-Up After Hospitalization Policy
2020-LHCC-611	Appeals Process	7/2/20	8/16/20	Completed	Appeals Process
2020-UHC-563	Actemra Criteria	7/2/20	8/16/20	Approved	Actemra Criteria
2020-UHC-570	Orencia Criteria	7/2/20	8/16/20	Approved	Orencia Criteria
2020-LHCC-331	Provider Manual	6/25/20	8/10/20	Approved	Provider Manual
2020-UHC-585	Chelation Therapy	6/25/20	8/10/20	Approved	Chelation Therapy
2020-PHARM-61	Hepatitis C DAA	6/22/20	8/7/20	Approved	Hepatitis C DAA
2020-ACLA-325	Provider Manual	6/18/20	8/3/20	Approved	Provider Manual
2020-HBL-115	Multiple Bilateral Article and Policy	6/18/20	8/3/20	Approved	Multiple Bilateral Article and Policy 1Multiple Bilateral Article and Policy 2
2020-HBL-120	Psychiatris Res Trmt Fac PRTF Gde, Med Gde and Withdrawal Gde	6/18/20	8/3/20	Approved	Psychiatris Res Trmt Fac PRTF Gde Med Gde Withdrawal Gde
2020-HBL-250	Provider Manual	6/18/20	8/3/20	Denied	Provider Manual
2020-UHC-324	Provider Manual	6/18/20	8/3/20	Approved	Provider Manual
2020-UHC-513	Epidural Steroid and Facet Injections for Spinal Pain (for Louisiana Only)	6/18/20	8/3/20	Approved	Epidural Steroid and Facet Injections for Spinal Pain (for Louisiana Only)
2020-UHC-516	Reimbursement Policy: Obstetrical Services Policy	6/18/20	8/3/20	Approved	Reimbursement Policy: Obstetrical Services Policy
2020-UHC-518	Reimbursement Policy: Global Days Policy	6/18/20	8/3/20	Approved	Reimbursement Policy: Global Days Policy
2020-UHC-519	Reimbursement Policy: Vaccines for Children	6/18/20	8/3/20	Approved	Reimbursement Policy: Vaccines for Children
2020-UHC-529	AIM Advanced Imaging Clinical Appropr. Guidelines	6/18/20	8/3/20	Approved	AIM Advanced Imaging Clinical Appropr. Guidelines 1 AIM Advanced Imaging Clinical Appropr. Guidelines 2 AIM Advanced Imaging Clinical Appropr. Guidelines 3 AIM Advanced Imaging Clinical Appropr. Guidelines 4
2020-UHC-531	AIM Advanced Imaging Clinical Appropr. Guidelines	6/18/20	8/3/20	Approved	AIM Advanced Imaging Clinical Appropr. Guidelines
2020-UHC-534	Add On Codes Policy	6/18/20	8/3/20	Approved	Add On Codes Policy 1 Add On Codes Policy 2
2020-PHARM-60	Multiple Sclerosis Agents for August 2020	6/15/20	7/30/20	Approved	Multiple Sclerosis Agents
2020-UHC-511	Manipulation Under Anesthesia	6/10/20	7/25/20	Approved	Manipulation Under Anesthesia
2020-UHC-512	Glaucoma Surgical Treatment	6/10/20	7/25/20	Approved	Glaucoma Surgical Treatment
2020-ABH-114	Limitations on Abortions	6/9/20	7/24/20	Approved	Limitations on Abortions
2020-ABH-496	Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR) Services	6/9/20	7/24/20	Approved	Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR) Services
2020-ACLA-368	Split Surgery Care	6/9/20	7/24/20	Approved	Split Surgery Care
2020-ACLA-380	Assistant Surgery Care	6/9/20	7/24/20	Approved	Assistant Surgery Care
2020-ACLA-381	Co-Surgery	6/9/20	7/24/20	Approved	Co-Surgery
2020-ACLA-484	Prior Authorization Requirements	6/9/20	7/24/20	Completed	Prior Authorization Requirements
2020-ACLA-495	Anesthesia Services for Gastrointestinal Endoscopy	6/9/20	7/24/20	Approved	Anesthesia Services for Gastrointestinal Endoscopy
2020-ACLA-507	Site of Care Medical Pharmacy	6/9/20	7/24/20	Approved	Site of Care Medical Pharmacy
2020-ACLA-508	Outpatient Surgical Procedures	6/9/20	7/24/20	Approved	Outpatient Surgical Procedures
2020-HBL-257	Pediatric Day Health Care and Personal Care Services	6/9/20	7/24/20	Approved	Pediatric Day Health Care and Personal Care Services
2020-HBL-319	Unlisted Unspecified Misc Codes Newsletter	6/9/20	7/24/20	Completed	Unlisted Unspecified Misc Codes Newsletter
2020-HBL-327	Distinct Procedural	6/9/20	7/24/20	Completed	Distinct Procedural
2020-HBL-359	Justice Involved Case Management	6/9/20	7/24/20	Approved	Justice Involved Case Management
2020-HBL-360	Durable Medical Equipment	6/9/20	7/24/20	Approved	Durable Medical Equipment
2020-HBL-415	Case Management Face to Face Intervention	6/9/20	7/24/20	Approved	Case Management Face to Face Intervention
2020-HBL-416	Unlisted Unspecified Misc Codes Policy	6/9/20	7/24/20	Completed	Unlisted Unspecified Misc Codes Policy
2020-HBL-485	Standing Referral	6/9/20	7/24/20	Completed	Standing Referral
2020-HBL-515	Louisiana Provider Payment Suspension (Hold)	6/9/20	7/24/20	Completed	Louisiana Provider Payment Suspension (Hold)
2020-LHCC-314	Infusion Therapy Site Of Care Optimization	6/9/20	7/24/20	Approved	Infusion Therapy Site Of Care Optimization
2020-LHCC-315	Testing Select GU Conditions	6/9/20	7/24/20	Approved	Testing Select GU Conditions
2020-LHCC-334	Disease Management Policies	6/9/20	7/24/20	Approved	Disease Management Policies
2020-LHCC-335	Quality Program Description	6/9/20	7/24/20	Approved	Quality Program Description
2020-LHCC-336	Care Management Program Description	6/9/20	7/24/20	Completed	Care Management Program Description
2020-LHCC-338	Perinatal Substance Use Disorder Care Management Program	6/9/20	7/24/20	Approved	Perinatal Substance Use Disorder Care Management Program
2020-LHCC-342	Medical Record Review	6/9/20	7/24/20	Completed	Medical Record Review
2020-LHCC-419	Provider Termination	6/9/20	7/24/20	Completed	Provider Termination
2020-LHCC-421	Provider Relations Demographic Provider Roster Affiliation Verification	6/9/20	7/24/20	Completed	Provider Relations Demographic Provider Roster Affiliation Verification
2020-LHCC-422	Network Development and Management	6/9/20	7/24/20	Completed	Network Development and Management
2020-LHCC-423	EPSDT	6/9/20	7/24/20	Approved	EPSDT
2020-LHCC-424	PASRR	6/9/20	7/24/20	Approved	PASRR
2020-LHCC-426	Adverse Incidents	6/9/20	7/24/20	Approved	Adverse Incidents
2020-LHCC-430	Covered Benefits and Services	6/9/20	7/24/20	Approved	Covered Benefits and Services
2020-LHCC-431	Monitoring Utilization	6/9/20	7/24/20	Approved	Monitoring Utilization
2020-LHCC-432	Psychiatric Treatment Facility	6/9/20	7/24/20	Approved	Psychiatric Treatment Facility
2020-LHCC-497	Emergency Services Policy	6/9/20	7/24/20	Completed	Emergency Services Policy
2020-LHCC-499	Retrospective Review For Services Requiring Authorizations	6/9/20	7/24/20	Completed	Retrospective Review For Services Requiring Authorizations
2020-LHCC-500	Policy, Procedure and Job Description Guidelines Policy	6/9/20	7/24/20	Completed	Policy, Procedure and Job Description Guidelines Policy
2020-LHCC-501	Access to Non-Emergency Transportation policy	6/9/20	7/24/20	Approved	Access to Non-Emergency Transportation policy
2020-LHCC-502	Clinical Information and Documentation Policy	6/9/20	7/24/20	Completed	Clinical Information and Documentation Policy
2020-LHCC-503	Evaluation of the Accessibility of services	6/9/20	7/24/20	Completed	Evaluation of the Accessibility of services
2020-LHCC-504	Quality PIPs policy	6/9/20	7/24/20	Approved	Quality PIPs policy
2020-LHCC-525	Remote Field Staff Quarterly HIPPA and Equipment audit policy	6/9/20	7/24/20	Completed	Remote Field Staff Quarterly HIPPA and Equipment audit policy
2020-LHCC-526	TruCare Standards for Documentation policy	6/9/20	7/24/20	Completed	TruCare Standards for Documentation policy
2020-LHCC-527	Organizational Cultural Competency policy	6/9/20	7/24/20	Completed	Organizational Cultural Competency policy
2020-LHCC-528	Public Records Request policy	6/9/20	7/24/20	Completed	Public Records Request policy
2020-UHC-374	Electrical and Ultrasound Bone Growth Stimulators	6/9/20	7/24/20	Completed	Electrical and Ultrasound Bone Growth Stimulators
2020-UHC-382	Benlysta (Belimumab)	6/9/20	7/24/20	Completed	Benlysta (Belimumab)
2020-UHC-383	Oncology Medication Clinical Coverage	6/9/20	7/24/20	Completed	Oncology Medication Clinical Coverage
2020-UHC-384	Intravenous Iron Replacement Therapy (Feraheme & Injectafer)	6/9/20	7/24/20	Completed	Intravenous Iron Replacement Therapy (Feraheme & Injectafer)
2020-UHC-385	Ketalar (Ketamine) and Spravato (Esketamine)	6/9/20	7/24/20	Completed	Ketalar (Ketamine) and Spravato (Esketamine)
2020-UHC-386	Luxturna (Voretigene Neparvovec-rzyl)	6/9/20	7/24/20	Completed	Luxturna (Voretigene Neparvovec-rzyl)
2020-UHC-387	Review At Launch For New To Market Medications	6/9/20	7/24/20	Completed	Review At Launch For New To Market Medications
2020-UHC-389	Somatostatin Analogs	6/9/20	7/24/20	Completed	Somatostatin Analogs
2020-UHC-390	Vyondys 53 (Golodirsen)	6/9/20	7/24/20	Completed	Vyondys 53 (Golodirsen)
2020-UHC-391	Zulresso (Brexanolone)	6/9/20	7/24/20	Completed	Zulresso (Brexanolone)
2020-UHC-392	Alpha1-Proteinase Inhibitors	6/9/20	7/24/20	Completed	Alpha1-Proteinase Inhibitors
2020-UHC-393	Botulinum Toxins A and B	6/9/20	7/24/20	Completed	Botulinum Toxins A and B
2020-UHC-394	Denosumab (Prolia & Xgeva)	6/9/20	7/24/20	Completed	Denosumab (Prolia & Xgeva)
2020-UHC-396	Exondys 51 (Eteplirsen)	6/9/20	7/24/20	Approved	Exondys 51 (Eteplirsen)
2020-UHC-397	Ilaris (Canakinumab)	6/9/20	7/24/20	Completed	Ilaris (Canakinumab)
2020-UHC-398	Intravenous Enzyme Replacement Therapy (ERT) for Gaucher Disease	6/9/20	7/24/20	Completed	Intravenous Enzyme Replacement Therapy (ERT) for Gaucher Disease
2020-UHC-399	Buprenorphine (Probuphine & Sublocade)	6/9/20	7/24/20	Approved	Buprenorphine (Probuphine & Sublocade)
2020-UHC-400	Compliment Inhibitors (SOLIRIS & ULTOMIRIS)	6/9/20	7/24/20	Completed	Compliment Inhibitors (SOLIRIS & ULTOMIRIS)
2020-UHC-401	Crysvita (BUROSUMAB-TWZA)	6/9/20	7/24/20	Completed	Crysvita (BUROSUMAB-TWZA)
2020-UHC-402	Denied Drug Codes - Pharmacy Benefit Drugs	6/9/20	7/24/20	Approved	Denied Drug Codes - Pharmacy Benefit Drugs
2020-UHC-403	Enzyme Replacement Therapy	6/9/20	7/24/20	Completed	Enzyme Replacement Therapy
2020-UHC-404	Erythropoiesis Stimulating Agents	6/9/20	7/24/20	Completed	Erythropoiesis Stimulating Agents
2020-UHC-405	Gonadatropin Releasing Hormones	6/9/20	7/24/20	Approved	Gonadatropin Releasing Hormones
2020-UHC-406	Immune Globulin (IVIG and SCIG)	6/9/20	7/24/20	Approved	Immune Globulin (IVIG and SCIG)
2020-UHC-407	Krystexxa	6/9/20	7/24/20	Completed	Krystexxa
2020-UHC-408	Maximum Dosage	6/9/20	7/24/20	Approved	Maximum Dosage
2020-UHC-409	Opthalmologic VEGF Inhibitors	6/9/20	7/24/20	Approved	Opthalmologic VEGF Inhibitors
2020-UHC-410	Sodium Hyaluronate	6/9/20	7/24/20	Approved	Sodium Hyaluronate
2020-UHC-411	Tysabri	6/9/20	7/24/20	Approved	Tysabri
2020-UHC-412	WBC-CSF	6/9/20	7/24/20	Approved	WBC-CSF
2020-UHC-413	Addendum to BH Utilization Management	6/9/20	7/24/20	Approved	Addendum to BH Utilization Management
2020-UHC-417	Prior Authorization Requirements	6/9/20	7/24/20	Completed	Prior Authorization Requirements
2020-UHC-479	Cardiac Event Monitoring -Annual CPT/HCPCS Code Updates and MCG	6/9/20	7/24/20	Completed	Cardiac Event Monitoring -Annual CPT/HCPCS Code Updates and MCG
2020-UHC-481	CPT/HCPCS Updates     Prosthetic Devices	6/9/20	7/24/20	Approved	CPT/HCPCS Updates     Prosthetic Devices
2020-UHC-482	CPT / HCPCS Updates   Molecular Oncology Testing	6/9/20	7/24/20	Approved	CPT / HCPCS Updates   Molecular Oncology Testing
2020-UHC-483	CPT/HCPCS Updates  Genetic Testing for Hereditary Cancer	6/9/20	7/24/20	Approved	CPT/HCPCS Updates  Genetic Testing for Hereditary Cancer
2020-UHC-493	Surgical Treatment for Spine Pain	6/9/20	7/24/20	Completed	Surgical Treatment for Spine Pain
2020-UHC-509	Breast Reconstruction Post Mastectomy	6/9/20	7/24/20	Approved	Breast Reconstruction Post Mastectomy
2020-UHC-510	COLLAGEN CROSSLINKS AND BIOCHEMICAL MARKERS OF BONE TURNOVER	6/9/20	7/24/20	Approved	COLLAGEN CROSSLINKS AND BIOCHEMICAL MARKERS OF BONE TURNOVER
2020-UHC-520	Panniculectomy Body Contouring Procedures	6/9/20	7/24/20	Approved	Panniculectomy Body Contouring Procedures
2020-UHC-521	Gastrointestinal Motility Disorders Diagnosis and Treatment	6/9/20	7/24/20	Approved	Gastrointestinal Motility Disorders Diagnosis and Treatment
2020-UHC-523	Intrauterine Fetal Surgery	6/9/20	7/24/20	Approved	Intrauterine Fetal Surgery
2020-UHC-524	DME Repairs and Replacements	6/9/20	7/24/20	Approved	DME Repairs and Replacements
2020-UHC-530	Reimbursement Policy: DRUG TESTING POLICY	6/9/20	7/24/20	Approved	Reimbursement Policy: DRUG TESTING POLICY
2020-PHARM-59	Acne Agents	5/29/20	7/13/20	Approved	Acne Agents
2020-PHARM-58	Acne Criteria	5/29/20	7/13/20	Approved	Acne Criteria
2020-PHARM-57	Adakveo	5/29/20	7/13/20	Approved	Adakveo
2020-PHARM-56	CGRP Antagonists	5/29/20	7/13/20	Approved	CGRP Antagonists
2020-PHARM-55	Colony Stimulating Factors	5/29/20	7/13/20	Approved	Colony Stimulating Factors
2020-PHARM-54	Diabetes Hypoglycemics Incretin Mimetics Enhancers	5/29/20	7/13/20	Approved	Diabetes Hypoglycemics Incretin Mimetics Enhancers
2020-PHARM-53	Egrifta	5/29/20	7/13/20	Approved	Egrifta
2020-PHARM-52	Keveyis	5/29/20	7/13/20	Approved	Keveyis
2020-PHARM-51	Multiple Sclerosis Agents Immunomodulatory Agents	5/29/20	7/13/20	Approved	Multiple Sclerosis Agents Immunomodulatory Agents
2020-PHARM-50	Multiple Sclerosis Agents	5/29/20	7/13/20	Approved	Multiple Sclerosis Agents
2020-PHARM-49	Other Behavioral Health Under 6	5/29/20	7/13/20	Approved	Other Behavioral Health Under 6
2020-PHARM-48	Otrexup Rasuvo	5/29/20	7/13/20	Approved	Otrexup Rasuvo
2020-PHARM-47	Pain Management Antimigraine Agents CGRP Antagonists	5/29/20	7/13/20	Approved	Pain Management Antimigraine Agents CGRP Antagonists
2020-PHARM-46	Pain Management Antimigraine Agentss Triptans 5/27/20	5/29/20	7/13/20	Approved	Pain Management Antimigraine Agentss Triptans 5/27/20
2020-PHARM-45	Pain Management Antimigraine Agents Triptans 5/26/20	5/29/20	7/13/20	Approved	Pain Management Antimigraine Agents Triptans 5/26/20
2020-PHARM-44	POS Document for May DUR	5/29/20	7/13/20	Approved	POS Document for May DUR
2020-PHARM-43	Ranexa	5/29/20	7/13/20	Approved	Ranexa