Medicare Medical Policies for
Louisiana and HMO Louisiana, Inc.

Medicare Advantage plans do follow Medicare guidelines; however, claims processing decisions are left to the discretion of the plan.

To access Commercial Medical Policies, click here

Medical Policy Search

You may use the field to narrow your focus by searching for keyword(s), procedure code(s), policy name or policy number.

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Blue Advantage uses InterQual criteria, which can be accessed (by providers and members) through the InterQual® Transparency Tool. Registration is required to access the InterQual tool.

Some medical drug policies may include a step therapy component as part of the criteria to determine medical necessity. The list of drugs which have this additional component can be viewed here: Medicare Part B (Medical Drug) Step Therapy List.

 

If an authorization for an ongoing course of treatment has been provided to a member and the member changes from one health plan to another health plan (e.g., a member moves from carrier A to Louisiana Blue), Louisiana Blue may honor the previous health plan’s authorization for the same service under the same type of in-network benefit for a 90-day transition period. Documentation of the authorization for the ongoing course of treatment from the previous health plan must be provided to us by the member or their provider and the services provided for the course of treatment must otherwise be a covered service under the Louisiana Blue health plan.

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