MedicaidDocumentationHigh impact
Crisis Stabilization for Adults - MEDICAID - LOUISIANA (New)
Humana·LA · Psychiatry, Emergency Medicine·Medicaid
Effective date
Jan 29, 2025
We identified it
Jun 25, 2026
Summary
Humana Louisiana Medicaid updated its Crisis Stabilization (CS) for Adults policy effective 01/29/2025 to include language for provisionally licensed LMHPs. CS is a short-term, bed-based crisis treatment service for adults 21+ at risk of hospitalization. Billing teams must ensure claims include proper concurrent review documentation post-24 hours, psychiatric evaluations by qualified providers, and care coordination records, or face retrospective denial and recoupment.
Action Required
By 02/28/2025: Billing team must implement the following changes: (1) Update billing system to flag all CS claims for mandatory concurrent review documentation after initial 24-hour period; (2) Require providers to document psychiatric evaluation by LMHP or psychiatrist with backup availability notation on all CS admission claims; (3) Ensure encounter forms capture care coordination activities (warm handoffs, follow-up within 72 hours, alternate provider referrals); (4) Establish internal audit process to verify crisis resolution/problem-solving documentation before claim submission to prevent retrospective denials; (5) Train billing staff that missing documentation supporting medical necessity will result in claim recoupment per policy language. Verify all CS claims submitted to Humana Healthy Horizons Louisiana include: initial notification of admission, daily discharge readiness assessments, and documented problem resolution or referral to alternate provider. Failure to include required documentation will result in denied claims and potential payment recoupment.