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Forms And Documents
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LA Pharmacy Directory
1.33 MB
Mar 27' 2025
Louisiana PBM MCO Provider Manual V1.5 FINAL 01.30.25 edited 02.27.25 (approved)
1.63 MB
Feb 27' 2025
LA MCO Drug Lookup Job Aid
0.29 MB
Feb 25' 2025
Lock-In Override Pharmacy Reminder JAN2025
0.21 MB
Feb 20' 2025
LA MCO Specialty Drug List
0.49 MB
Feb 05' 2025
Pharmacy Notice Cost Ceiling Multivitamins Claims 202501
0.14 MB
Jan 31' 2025
Pharmacy Notice Reprocessing Claims (Provider Fee) 01.23.25
0.23 MB
Jan 27' 2025
Pharmacy Notice Age Limits
0.15 MB
Dec 27' 2024
Pharmacy Notice Quantity Limits
0.16 MB
Dec 27' 2024
LA MCO Physician Administered Drug List (Updated 12.19.24)
0.3 MB
Dec 19' 2024
Pharmacy Notice Prenatal Vitamins
0.14 MB
Dec 09' 2024
LA_Palivizumab_PA_Form
0.67 MB
Oct 29' 2024
Pharmacy Notice GLP-1s Therapeutic Duplication
0.17 MB
Sep 27' 2024
Pharmacy Notice - Clotting Factors
0.22 MB
Sep 24' 2024
Pharmacy Notice GLP-1s Quantity Limits
0.17 MB
Sep 19' 2024
Pharmacy Notice - OCC1 Removal
0.28 MB
Sep 18' 2024
Pharmacy Notice GLP-s High Dose
0.17 MB
Sep 04' 2024
Pharmacy Notice - PAD (Effective 09.01.24)
0.16 MB
Aug 29' 2024
Pharmacy notification updated communication vaccine dispense fees
0.21 MB
Aug 27' 2024
Pharmacy Notice Vaccine
0.16 MB
Aug 26' 2024
LA MCO Pharmacy Notice GLP1 and DPP4
0.18 MB
Jul 12' 2024
Pharmacy Notice - POS Rejection
0.17 MB
Jul 02' 2024
LA MCO Pharmacy Notice
0.16 MB
May 09' 2024
LA MCO Pharmacy Notice Claims Processing System
0.12 MB
May 09' 2024
LA Medicaid Pharmacy Reimbursement Policy
0.26 MB
May 03' 2024
LA MCO Pharmacy Notice Shipping Policy
0.13 MB
Apr 29' 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
LA MCO Quantity Limits Overrides
0.19 MB
Dec 15' 2023
LDH_Plan_Reminder 11.6.23
0.15 MB
Nov 07' 2023
LA Medicaid COB Processing Requirements
0.09 MB
Nov 06' 2023
LDH_30-day_Provider_Notice
0.19 MB
Oct 30' 2023
LA Grievance and Complaint Form
0.68 MB
Oct 30' 2023
LA MCO D.0 Payer Specs
0.75 MB
Oct 26' 2023
Louisiana Department of Health 30-Day Provider Notice
0.19 MB
Oct 26' 2023
LDH_60-day_Provider_Notice
0.13 MB
Aug 09' 2023
LA MCO D.0 Payer Specs
0.75 MB
Oct 26' 2023
LA MCO Drug Lookup Job Aid
0.29 MB
Feb 25' 2025
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
0.49 MB
Feb 05' 2025
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
1.33 MB
Mar 27' 2025
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
Lock-In Override Pharmacy Reminder JAN2025
0.21 MB
Feb 20' 2025
Louisiana Department of Health 30-Day Provider Notice
0.19 MB
Oct 26' 2023
Louisiana PBM MCO Provider Manual V1.5 FINAL 01.30.25 edited 02.27.25 (approved)
1.63 MB
Feb 27' 2025
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 Age Limits
0.15 MB
Dec 27' 2024
Pharmacy Notice Cost Ceiling Multivitamins Claims 202501
0.14 MB
Jan 31' 2025
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 Quantity Limits
0.16 MB
Dec 27' 2024
Pharmacy Notice Reprocessing Claims (Provider Fee) 01.23.25
0.23 MB
Jan 27' 2025
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
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