Complex Case Management

Louisiana Blue’s Complex Case Management Program identifies members with complex healthcare needs based upon their chronic condition. The goal of Complex Case Management is to help members regain optimal health or improved functional capability, educate members regarding their chronic condition, teach members about self-management and preventive care, reinforce the primary care provider’s (PCP) prescribed treatment plan and provide information on resources that are available to our members.

The program is a telephonic case management program and involves a comprehensive assessment of the member’s condition, determination of available benefits and resources, development and implementation of a plan of care and coordination of services. After a member has been identified for Complex Case Management, a registered nurse (RN) case manager will contact the member to perform an initial assessment and develop a plan of care. The case manager works closely with the member and the member’s provider(s) to coordinate care.

Enrollment criteria for Complex Case Management include but are not limited to the following diagnoses and an inpatient admission, discharge or emergency room discharge:

  • Congestive Heart Failure (CHF)
  • Hypertension
  • Atrial Fibrillation
  • Coronary Artery Disease

Resources that we can assist you with if needed:

  • Medication Therapy Management
  • Tobacco Cessation Program by Certified Educators
  • Diabetes Education
  • Nutritional Services
  • Diabetes and Chronic Obstructive Pulmonary Disease (COPD) Disease Management
  • Social Health Coaching
  • Behavioral Health Case Management

Referral identification sources include but are not limited to:

  • Provider Referrals
  • Discharge Planning or Transitional Care
  • Member Self-Referral
  • Family Referrals
  • Utilization Management Referrals
  • Admit, Discharge and Transfer Data

Referral Process:
Each referral is reviewed for enrollment in Complex Case Management based on available information and telephonic member assessment. Participation in this program is voluntary and at no cost for all eligible Louisiana Blue members. If you would like to refer a member or if you would like additional information regarding eligibility in the Complex Case Management Program, please call toll-free 1-800-317-2299 (TTY 711).