Prior Authorization

Some services require Prior Authorization (PA) from Louisiana Healthcare Connections in order for reimbursement to be issued to the provider. To determine if a service requires PA, please use our Prior Authorization Prescreen Tool.

Standard PA requests should be submitted for medical necessity review at least seven (7) business days before the scheduled service delivery date or as soon as the need for service is determined. Failure to obtain authorization may result in an administrative claim denial.

As a reminder, Louisiana Healthcare Connections providers are contractually prohibited from holding any member financially liable for any service administratively denied by Louisiana Healthcare Connections for failure on behalf of the provider to obtain a timely authorization.

PA requests may be submitted by fax, by phone or by Secure Web Portal using our updated Prior Authorization Fax Forms (Inpatient Fax Form, Outpatient Fax Form). PA requests must include all necessary clinical information. Urgent PA requests should be submitted as soon as the need for the service is determined. Review PA Fax Form FAQs.

Fax the following PA requests to the corresponding fax number:

Form Fax Number           
Inpatient Fax Form/Admissions/Face Sheet 1-877-401-8175
Outpatient Fax Form/Medical Services/Home Health 1-877-401-8175
Concurrent Review–Clinical/Census 1-877-668-2080
Outpatient Therapy (Cenpatico/STRS) 1-855-254-1798
High Tech Imaging (NIA) 1-888-656-3602
Vision (Opticare) 1-252-451-2133

 

High Tech Imaging Services (CT, MRI) are authorized by National Imaging Associates at www.radmd.com.

For Mental Health Services outside of Bayou Health, please fax to
1-800-424-4399.

For more information, please refer to your Provider Manual (Nov. 2014).

Helping Providers Help Patients

Louisiana Healthcare Connections’ Medical Home program is designed to give providers the tools they need to strengthen the critical doctor-patient relationship. The Medical Home is a system of care led by a team of primary care providers who partner with the patient, the patient’s family and the community to coordinate care in all settings, from specialists and hospitals to pharmacies, mental health programs, and home health agencies.

As a Medical Home, your practice is able to coordinate all of your patient’s health care needs—including treatment and referrals—and incorporate dynamic resources such as open scheduling, expanded hours and direct communication to more effectively manage your patients’ care.

Is your practice a nationally recognized Patient Centered Medical Home?

If not, your personal Patient Centered Medical Home Manager Gwen Laury, RN, CCHC, PCMH-CCE is waiting for your call. To find out more, e-mail glaury@centene.com or call (225)-201-8430.