Policies and Procedures

The following CHRISTUS claim policies are to assist providers when submitting claims and to provide information on how CHRISTUS processes claims for the service in reference. Policies are subject to change and will be updated to reflect any changes made. These policies do not guarantee payment of a claim.

• Accessibility of Network
• Annual Attestations from FDRs
• Annual Compliance Program Effectiveness Assessment- Medicare Advantage 
• Behavioral Health Care and Physical Health Care Coordination
• Breach Notification PHI- Reporting Guideline
• Claims Processing Submission Guidelines
• Coordination between the BH Provider and the PCP
• Code of Ethics
• Code of Ethics for CHRISTUS Health Plan Louisiana
• Communications Regarding Regulatory Changes and Deliverable Ticker
• Compliance Training and Education
• Corrective Action
• Coverage Determination Oversight and Monitoring
• Delegated Member Call Center Oversight and Monitoring
• Durable Medical Equipment (DME)
• Emergency Medical and Urgently Needed Services Claims
• Follow-up after Hospitalization for Behavioral Health Services 
• Fraud, Waste and Abuse
• Genetic Testing for High Risk Colorectal Cancer
• Inpatient Concurrent Review 
• Medical Director Initial Review
• Medical Record Policy
• Member Education and Self-Referral for Behavioral Health Services
• Member Privacy Rights 
• Member Rights and Responsibilities 
• Monitoring and Auditing
• Network Provider Education
• Non-Contract Provider Appeal
• Non-Discrimination Notice
• Non Retaliation Policy
• Observation Stay Review
• Out of Network (OON) Prior Authorization
• Prior Authorization for Hospice Care
• Provider Complaints and Appeals
• Preventative Colorectal Cancer Screening with Additional Services 
• Quality- Patient Safety Indicator Evaluation
• Reimbursement Policy- Routine Venipuncture and/or Collection of Specimens
• Skilled Nursing Facility Utilization Review
• Transition Supply Process Oversight and Monitoring
• Transplant Policy