Fair Notice Compliance | Louisiana Department of Health
For Providers
Medicaid Providers
Fair Notice Compliance
Fair Notice Compliance
The Louisiana Department of Health (LDH) provides guidance for all contractors that produce denial and partial denial notices.  These notices are monitored to ensure compliance with the 42 Code of Federal Regulations (CFR) relative to timely and adequate notices of benefit determinations for prior authorized services.  This auditing and monitoring is being continued in the spirit of the previous litigation, better known as Wells v. Gee.
Resources
As a result of the Joint stipulation from the Wells v. Gee settlement LDH, in collaboration with the plaintiff’s council, developed multiple templates to help contractors, program offices, and Managed Care Organizations (MCO) maintain compliance with the CFR as it pertains to the development of denial and partial denial notices of prior authorized services. LDH strongly encourages continued use of these templates as a resource tool to assist with compliance.
DISCLAIMER:  The information contained in this website is provided for informational purposes only. It is the responsibility of each contractor to stay current on all applicable state and federal rules and regulations, policies and contract requirements.
Compliance Templates for MCOs and Gainwell Technologies ONLY
*MCO and non-MCO appeal timelines may vary according to the 42 CFR
Denial Template
- Non-service specific (effective 09/01/21)
Denial Template Example
- Non-service specific (effective 09/01/21)
Partial Denial Template
(Non-service specific)
Partial Denial Template Example
(Non-service specific
effective 07/01/20
CPST/PSR Denial Template
(effective 11/01/21)
CPST/PSR Denial Template Example
(effective 11/01/21)
CPST/PSR Partial Denial Template
(effective 11/01/21)
CPST/PSR Partial Denial Template Example
(effective 11/01/21)
Pediatric Day Health Care (PDHC) Denial Template
(effective 11/25/24)
Pediatric Day Health Care (PDHC) Denial Template Example 1
(effective 11/25/24)
Pediatric Day Health Care (PDHC) Denial Template Example 2
(effective 11/25/24)
Untimely Decision Template
(effective 11/01/21)
Untimely Decision Template Example
(effective 11/01/21)
Compliance Templates for Dental PAHP ONLY
Hospital Dentistry Partial Denial Template
(effective 11/01/21)
Hospital Dentistry Partial Denial Example
(effective 11/01/21)
Helpful Tools
Fair Notice Companion Guide
Fair Notice Process Guide
Electronic Code of Federal Regulations
Louisiana Medicaid Provider Manuals
Wells Court Documents
Wells vs. Gee Settlement
Partial Resolution
(11/01/16)
Court Ruling
(07/31/17)
Joint Stipulation in Settlement
(10/31/19)
Surgeon General
Evelyn Griffin, MD
Secretary
Bruce D. Greenstein
Cicero Government