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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 Quantity Limits Overrides
0.19 MB
Dec 15' 2023
LA MCO Specialty Drug List
1.02 MB
Apr 30' 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
0.94 MB
Jul 22' 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 V1.3 (002)
1.68 MB
Apr 23' 2024
Pharmacy Notice - POS Rejection
0.17 MB
Jul 02' 2024
LA Grievance and Complaint Form
0.68 MB
Oct 30' 2023
LA_AUD_Form
0.69 MB
Oct 30' 2023
LDH_30-day_Provider_Notice
0.19 MB
Oct 30' 2023
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