Prior Authorization
Please note, failure to obtain authorization may result in administrative claim denials. Louisiana Healthcare Connections providers are contractually prohibited from holding any member financially liable for any service administratively denied by Louisiana Healthcare Connections for the failure of the provider to obtain timely authorization.
Check to see if a pre-authorization is necessary by using our online tool.
Expand the links below to find out more information.
As the Medical Home, PCPs should coordinate all healthcare services for Louisiana Healthcare Connections members. Paper referrals are not required to direct a member to a specialist within our participating network of providers. All out of network services (excluding ER and family planning) require prior authorization. PCPs should track receipt of consult notes from the specialist provider and maintain these notes within the patient’s medical record.
Some services require prior authorization from Louisiana Healthcare Connections in order for reimbursement to be issued to the provider. See our Prior Authorization List, which will be posted soon, or use our Prior Authorization Prescreen tool.
Standard prior authorization requests should be submitted for medical necessity review at least seven business days before the scheduled service delivery date or as soon as the need for service is identified. Failure to obtain authorization may result in an administrative claim denial.
Urgent PA requests should be submitted as soon as the need for the service is determined.
Authorization requests may be submitted by fax, phone or secure web portal and should include all necessary clinical information.
Emergent and post-stabilization services do not require prior authorization. Urgent/emergent admissions require notification within one (1) business day following the admit date.
We will process most routine authorizations within five business days. If we need additional clinical information or the case needs to be reviewed by the Medical Director it may take up to 14 calendar days to be notified of the determination. Authorization determinations may be communicated to the provider by fax, phone, secure email, or secure web portal.
Louisiana Healthcare Connections’s hours of operation are Monday through Friday, 7a.m. to 7p.m. (excluding holidays). After normal business hours, staff is available to answer questions and intake requests for prior authorization.
If you have questions about prior authorization criteria, email us at PACriteriaRequest@LouisianaHealthConnect.com and we'll get back to you within 24 hours.