Updated Sterilization Consent Form (IB 22-27)

Date: 08/18/22

Louisiana Healthcare Connections would like to let providers know of a revised and published sterilization consent form. This form has an update expiration date of July 31, 2025. This form is effective immediately.

Due to potential technical issues with accessing the OPA website until August 1, 2022, the prior form will be accepted for consents signed on or before July 31, 2022.

Providers are responsible for using the most current form published on the OPA website on the date the consent is obtained.

Regardless of the consent form signed, Fee-for-Service providers must adhere to the sterilization policy requirements as outlined in the Professional Services provider manual. MCO providers are to adhere to policy requirements in the MCOs’ provider handbooks.

Questions regarding this message and Fee-for-Service claims/consents are to be directed to Gainwell Technologies Provider Relations at (800) 473-2783 or (225) 924-5040.

The new forms are available on our website in English (PDF) and Spanish (PDF). If providers have any questions, please contact Provider Services at 1-866-595-8133.