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Electronic Prior Authorization (ePA)
Prior Authorization Forms
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Prior Authorizations
LA Palivizumab PA Form
0.62 MB
Jun 11' 2024
LA_Aduhelm_PA_Form
0.83 MB
Jun 11' 2024
LA_DAA_HepC_Therapy_Worksheet
0.55 MB
Jun 11' 2024
LA_HepC_Patient_Agreement
0.56 MB
Jun 11' 2024
LA_Leqembi_PA_Form
0.8 MB
Jun 11' 2024
LA_Spinraza_PA_Form
0.62 MB
Jun 11' 2024
LA_Uniform_PA_Form
0.6 MB
Jun 11' 2024
LA MCO D.0 Payer Specs
0.75 MB
Oct 26' 2023
LA MCO Pharmacy Notice
0.16 MB
May 09' 2024
LA MCO Pharmacy Notice Claims Processing System
0.12 MB
May 09' 2024
LA MCO Pharmacy Notice GLP1 and DPP4
0.18 MB
Jul 12' 2024
LA MCO Pharmacy Notice Shipping Policy
0.13 MB
Apr 29' 2024
LA MCO Physician Administered Drug List (Updated 12.19.24)
0.3 MB
Dec 19' 2024
LA MCO Quantity Limits Overrides
0.19 MB
Dec 15' 2023
LA MCO Specialty Drug List
0.57 MB
Nov 07' 2024
LA Medicaid COB Processing Requirements
0.09 MB
Nov 06' 2023
LA Medicaid Pharmacy Reimbursement Policy
0.26 MB
May 03' 2024
LA Pharmacy Directory
0.99 MB
Dec 20' 2024
LA_MCO_Compounding Claims Submission 03.22.24 (002)
0.15 MB
Mar 22' 2024
LA_MCO_Refill_Too_Soon_Pharmacy_Notice 03.04.24_ER
0.19 MB
Mar 07' 2024
LA_MCO_Submitting PA_Requests_Using_CoverMyMeds 02.02.24
0.83 MB
Feb 05' 2024
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 PBM MCO Provider Manual V1.5 FINAL
1.59 MB
Nov 01' 2024
Memo Hurricane Francine 20240911
0.42 MB
Sep 11' 2024
Pharmacy Notice - Clotting Factors
0.22 MB
Sep 24' 2024
Pharmacy Notice - OCC1 Removal
0.28 MB
Sep 18' 2024
Pharmacy Notice - PAD (Effective 09.01.24)
0.16 MB
Aug 29' 2024
Pharmacy Notice - POS Rejection
0.17 MB
Jul 02' 2024
Pharmacy Notice GLP-1s Quantity Limits
0.17 MB
Sep 19' 2024
Pharmacy Notice GLP-1s Therapeutic Duplication
0.17 MB
Sep 27' 2024
Pharmacy Notice GLP-s High Dose
0.17 MB
Sep 04' 2024
Pharmacy Notice Prenatal Vitamins
0.14 MB
Dec 09' 2024
Pharmacy Notice Vaccine
0.16 MB
Aug 26' 2024
Pharmacy notification updated communication vaccine dispense fees
0.21 MB
Aug 27' 2024
LA Grievance and Complaint Form
0.68 MB
Oct 30' 2023
LA_Palivizumab_PA_Form
0.67 MB
Oct 29' 2024
LDH_30-day_Provider_Notice
0.19 MB
Oct 30' 2023
Amagat
