Documentation Requirements for Hysterectomy and Sterilization - MEDICAID - LOUISIANA (New)

REQUIREMENTS: Before 07/29/2026: - Billing team must update claim submission workflows to require hysterectomy consent form (BHSF Form 96-A) or physician written certification before processing reimbursement for any hysterectomy procedure. - Billing team must update claim submission workflows to require sterilization consent form (HHH-687 English or HHH-687-1 Spanish) with ALL required signatures (patient, interpreter if applicable, consent obtainer, performing physician) before processing reimbursement. - Update billing system to flag claims requiring consent documentation and prevent claim submission without supporting documentation attached. - Create internal audit checklist for staff reviewing hysterectomy/sterilization claims to verify: (1) Consent form signed and dated by enrollee on or before procedure date; (2) Witness signature present if patient unable to sign or mental incapacity diagnosed; (3) Witness signature date matches enrollee signature date; (4) Enrollee name on Medicaid file matches name on consent form; (5) For sterilization: 30-180 day waiting period documented (72 hours for emergency/premature delivery cases). - Ensure billing team has access to current forms at https://www.lamedicaid.com (hysterectomy) and https://opa.hhs.gov/grant-programs/title-x-service-grants/key-resources-title-x-grantee-recipients (sterilization). - Instruct providers that consent forms must be shared with all involved providers (attending physician, hospital, anesthesiologist, assistant surgeon) and original forms submitted with claims. - For name changes on Medicaid file: Require provider to submit signed physician letter stating name change with member's SSN and DOB attached to all affected claims. - Communicate to providers: Claims for hysterectomy or sterilization will be DENIED without proper consent documentation; exceptions (pre-existing sterility, life-threatening emergency, retroactive Medicaid certification) require physician written certification. - Billing team must retain all consent documentation and maintain per Louisiana Department of Health requirements (documents cannot be shredded without prior LDH approval).