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Electronic Prior Authorization (ePA)
Prior Authorization Forms
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Prior Authorizations
LA_Aduhelm_PA_Form
0.83 MB
May 07' 2024
LA_DAA_HepC_Therapy_Worksheet
0.55 MB
May 07' 2024
LA_HepC_Patient_Agreement
0.56 MB
May 07' 2024
LA_Leqembi_PA_Form
0.8 MB
May 07' 2024
LA_Palivizumab_PA_Form
0.62 MB
May 07' 2024
LA_Uniform_PA_Form
0.6 MB
Jun 12' 2024
LA MCO D.0 Payer Specs
0.75 MB
Oct 26' 2023
LA Medicaid COB Processing Requirements
0.09 MB
Nov 06' 2023
LDH_60-day_Provider_Notice
0.13 MB
Aug 09' 2023
LDH_Plan_Reminder 11.6.23
0.15 MB
Nov 07' 2023
Louisiana Department of Health 30-Day Provider Notice
0.19 MB
Oct 26' 2023
Louisiana Department of Health Specialty List
0.26 MB
Oct 26' 2023
Louisiana PBM MCO Provider Manual
1.96 MB
Oct 06' 2023
Louisiana Pharmacy Directory 10-09-2023
0.22 MB
Oct 16' 2023
LA Grievance and Complaint Form
0.68 MB
Oct 30' 2023
LA_AUD_Form
0.69 MB
Oct 30' 2023
LA_DAA_HepC_Therapy_Worksheet
0.55 MB
Oct 30' 2023
LA_HepC_Patient_Agreement
0.56 MB
Oct 30' 2023
LDH_30-day_Provider_Notice
0.19 MB
Oct 30' 2023
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