Temporary Authorization Requirements for Hospital and Related Services
Customize your policy alerts
Sign up for all blue cross blue shield - louisiana policy alerts
Know when blue cross blue shield - louisiana releases new policies or updates existing guidance.
Monitor payer policy activity
This document governs temporary changes to prior authorization requirements for credentialed Louisiana participating facilities during the COVID-19 crisis, affecting emergent and certain inter-facility transfers for Blue Cross and Blue Shield of Louisiana and HMO Louisiana, Inc. members.
No material clinical or coverage changes in this revision.
Temporary Authorization Criteria
Temporary Authorization Criteria
Temporary and standing authorization requirements and exceptions during the specified COVID-19 period.
Emergent inpatient admissions
- For initial inpatient admissions and acute hospital-to-acute hospital transfers, notify Blue Cross upon admission using normal processes (BCBSLA Authorizations tool, authorization number on Member ID card, or fax).
- Blue Cross Utilization Management will enter information and authorize all admissions for 7 days without medical review.
- At the end of 7 days Blue Cross will verify continued hospital stay and authorize additional days through discharge without medical review.
- Concurrent record review is suspended, including for patients admitted prior to March 16, 2020.
Transfers to LTACH / SNF / IRF
- For transfers from an acute care hospital to a credentialed Louisiana participating LTACH, SNF, or inpatient rehabilitation facility, the receiving facility must notify Blue Cross of the admission within 24 hours.
- Blue Cross will automatically approve a 3-day stay for the receiving facility pending review.
- Blue Cross will perform concurrent review by day 4 and authorize continued stay based on medical necessity.
Services that still require prior authorization
- Non-emergent hospitalizations (scheduled elective admissions) must be prior authorized.
- Behavioral health services (inpatient admissions, IOP, PHP, RTC, and ABA) must be prior authorized.
- Transplant services must be prior authorized.
Coding and Timeframes
| No codes listed |
Provider Notifications, Transfers, and Exceptions
Admission notification and 7‑day automatic authorization
For initial inpatient admissions and acute hospital-to-acute hospital transfers, notify Blue Cross upon admission using your normal process (BCBSLA Authorizations tool, authorization number on the Member ID card, or fax). Utilization Management will enter admission information and authorize all admissions for 7 days without medical review; at the end of 7 days they will verify continued stay and authorize through discharge without medical review. Concurrent record review is suspended, including for patients admitted prior to March 16, 2020.
- Notify Blue Cross upon admission using current authorization channels.
- Initial automatic authorization = 7 days without medical review.
- At day 7, BCBSLA will verify continued stay and extend authorization through discharge without medical review.
- Concurrent record review is suspended for admissions during the period and those admitted prior to March 16, 2020.
Receiving facility notification and 3‑day automatic approval
For transfers from an acute care hospital to a credentialed Louisiana participating LTACH, SNF, or inpatient rehabilitation facility, the receiving facility must notify Blue Cross of the admission within 24 hours. Blue Cross will automatically approve a 3-day stay for the receiving facility and will perform a concurrent review by day 4 to authorize any continued stay based on medical necessity.
- Receiving facility must notify Blue Cross within 24 hours of admission after transfer.
- Automatic approval for the receiving facility = 3 days.
- BCBSLA will conduct concurrent review by day 4 to determine continued authorization based on medical necessity.
Services that still require prior authorization
Certain services remain subject to prior authorization and must be obtained before the service is provided: non‑emergent (scheduled/elective) hospitalizations, behavioral health services (inpatient admissions, IOP, PHP, RTC, and ABA), and transplant services.
- Non-emergent hospitalizations (scheduled/elective) require prior authorization.
- Behavioral health services — inpatient admissions, intensive outpatient program (IOP), partial hospitalization program (PHP), residential treatment center (RTC), and applied behavior analysis (ABA) — require prior authorization.
- Transplant services require prior authorization.
Applicability — credentialed Louisiana participating facilities only
These temporary authorization provisions apply only to credentialed Louisiana participating in‑network facilities; they do not apply to non‑participating or out‑of‑state facilities. Blue Cross will allow in‑network level benefits to apply for credentialed Louisiana participating facilities for BCBSLA and HMO Louisiana, Inc. members even if the facility is not specifically in the member's network.
- Scope limited to credentialed Louisiana participating (in‑network) facilities.
- Usual authorization processes apply for non‑participating or out‑of‑state facilities.
- In‑network level benefits may be applied for credentialed Louisiana participating facilities even if not in the member's specific network.
Key Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.