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2018-07: Adverse Incident Reporting Form & Instructions Updated

Date: 02/01/18

On January 4, 2018, Louisiana Healthcare Connections distributed Provider Notice 2018-01 indicating that the Louisiana Department of Health had updated the Healthy Louisiana Adverse Incident Reporting Form and the AI Reporting Form Instructions and Definitions. Providers should be advised that this form and its instructions have recently undergone another update by LDH. Effective February 1, 2018, healthcare providers are required to use the newly updated AI form to report adverse incidents to Louisiana’s Medicaid Managed Care Organizations, including Louisiana Healthcare Connections.

The updated AI Reporting Form and AI Reporting Form Instructions can be found on the Louisiana Healthcare Connections website:

  • Adverse Incident Reporting Form: www.lahealth.cc/adverseincidentform
  • Adverse Incident Reporting Form Instructions: www.lahealth.cc/adverseincidentforminstructions

TIP: When submitting an AI Reporting Form, please verify that you are utilizing the correct, current form. The updated AI Reporting Form indicates the version date of December 11, 2017, in the lower right corner.

REMINDER: As mandated reporters, and as required by Louisiana’s Children’s Code Title VI, Article 603, and LDH, healthcare providers are required to submit the AI Reporting Form within ONE business day of discovery of the adverse incident to the affected member’s Healthy Louisiana health plan.

LDH has provided the following example to clarify the “within one business day” reporting requirement: For example, if the time of discovery of the incident is on Friday at 4 p.m., and the reporting provider’s office closes at 5 p.m., the provider will have until the following Monday at 4 p.m. to report the incident to the appropriate Healthy Louisiana health plan.

For Louisiana Healthcare Connections members, the AI Reporting Form must be submitted via fax to 1-866-704-3063.

NOTE: If the incident is reportable to a protective agency, such as DCFS or APS, there must be documentation included in Section 4 of the AI Reporting Form that those agencies were informed immediately.

Healthcare providers are encouraged to use the following Frequently Asked Questions to educate their staffs about AI reporting requirements:

What is an adverse incident?

An adverse incident is defined as an unexpected occurrence that led to, or could have led to, serious unintended or unexpected harm, loss, or damage. Adverse incidents result in unintended harm to the patient by an act of commission or omission, rather than by the underlying disease or condition. These include, but are not limited to death, abuse and/or neglect.

Is the AI Reporting Form different for each Healthy Louisiana plan?

No. All of the Healthy Louisiana health plans, including Louisiana Healthcare Connections, use the same AI Reporting Form. Remember: the form must be submitted to the affected member’s health plan, not the state. Louisiana Healthcare Connections tracks and monitors providers to ensure compliance with the state’s adverse incident reporting requirements.

Where can providers get adverse incident training?

Louisiana Healthcare Connections provides regular Adverse Incident Reporting Training at no cost to providers. You can register for this training (and other free educational and training opportunities) by visiting www.envolveu.com.