State

Louisiana

Required Form

1010 Form (PDF)

Timely Response

Payor must respond to a 1010 Form within 5 days

Review

If the Payor denies authorization, or fails to respond timely, providers may file a Disputed Claim for Medical Treatment (Form 1009) with the OWCA. The Medical Director will then review the claim and issue a decision.

This form must be submitted within 15 calendar days of the 1010 denial.

Louisiana Revised Statutes

Revised Statutes - Title 23

Rule

§1142. Approval of health care providers; fees

Rule Text

B.  Nonemergency care.
(1)(a)  Except as provided herein, each health care provider may not incur more than a total of seven hundred fifty dollars in nonemergency diagnostic testing or treatment without the mutual consent of the payor and the employee as provided by regulation.  Except as provided herein, that portion of the fees for nonemergency services of each health care provider in excess of seven hundred fifty dollars shall not be an enforceable obligation against the employee or the employer or the employer's workers' compensation insurer unless the employee and the payor have agreed upon the diagnostic testing or treatment by the health care provider.