MedicaidPrior AuthHigh impact
Wound Care - MEDICAID - LOUISIANA (New)
Humana·LA · Wound Care, General Surgery, Internal Medicine +3 more·Medicaid
Effective date
Jan 20, 2025
We identified it
Jun 25, 2026
Summary
Humana Louisiana Medicaid (Healthy Horizons) implemented a new wound care prior authorization policy effective 01/20/2025. Wound care supplies now require prior authorization for three-month periods with specific documentation requirements (wound measurements, drainage, color, prescribed regimen, etc.), and wound care systems require PA for Stage III/IV chronic wounds or post-surgical conditions. Home health agency involvement is now mandatory for wound care supply approval.
Action Required
By January 20, 2025: (1) Billing team must implement prior authorization requirement in billing system for all wound care supply claims and wound care system claims submitted to Humana Louisiana Medicaid. (2) Update claim submission procedures to require PA approval before processing. (3) Providers submitting wound care claims must include in PA requests: accurate diagnostic information, medical history, wound measurements (length, width, depth, tunneling/undermining), wound appearance (color, drainage type/amount, odor), prescribed regimen with frequency/duration/supplies, infection treatment details, pressure-reducing device use documentation, and confirmation of home health agency involvement. (4) Front desk and clinical staff must verify home health agency involvement is documented before claim submission—claims without this verification will be denied. (5) Update encounter forms and EMR templates to prompt for required wound care documentation. (6) Establish process to resubmit PA requests with updated prescriptions for supply extensions beyond initial three-month authorization period. Failure to obtain prior authorization will result in claim denials from Humana Louisiana Medicaid.