Providers

• Training
  • Schedule an Orientation in Your Office
• Resources
  • Cultural Competency and Language Services
  • Credentialing
  • NaviNet
  • PCP Auto Assignment
  • Provider Directory
  • Provider Forms
  • Provider Grievances
  • Provider Handbook
  • Provider Marketing Guidelines
  • HIPAA
  • QAPI Program
• Clinical Information
  • Clinical Practice Guidelines
  • Preventive Health Guidelines
  • Preventive Pediatric Health Care
  • Member Rights and Responsibilities
  • Prior Authorization
  • Provider Reference Guide
  • Referrals
  • Flu Information
  • Pediatric Preventive Health Care Program (EPSDT)
• Billing
  • Billing Manual
  • Electronic Funds Transfer
  • Electronic Claims Submission (EDI)
  • Electronic Remittance Advice (ERA)
• Non-Contracted Providers
  • Continuity of Care for Non-participating Providers
  • Contracting Information
  • Non-Participating Provider Demographic Information Form
  • Prior Authorizations
• Communications
  • Contact Account Executive
  • DHH Information
  • ICD-10
  • LaCare Provider Letters
  • Newsletters
• Pharmacy

Continuity of Care for Non-participating Providers

LaCare provides continuing coverage of care for Members who are engaged in an ongoing course of treatment with a non-participating Practitioner/Provider to promote continuity of care in the following situations:

Newly Enrolled Members

• Who are receiving medically necessary covered services the day before becoming a LaCare Member, can continue to receive such medically necessary services for the first thirty (30) calendar days of enrollment, without prior authorization and without regard to whether such services are being provided by a participating or non-participating LaCare Practitioner/Provider. After thirty (30) calendar days, prior authorization requirements apply for those services identified as requiring prior authorization. LaCare will continue to provide coverage for services determined to be medically necessary for an additional sixty (60) calendar days or until the Member may be reasonably transferred without disruption, whichever is less. LaCare will not deny authorization solely on the basis that the Practitioner/Provider is not a participating LaCare Practitioner/Provider.

Newly Enrolled Pregnant Women

• Who are receiving medically necessary covered services in addition to, or other than, prenatal services (see below for newly enrolled Members receiving only prenatal services) the day before becoming a LaCare Member, can continue to receive such medically necessary services for the first thirty (30) calendar days of enrollment, without prior authorization and without regard to whether such services are being provided by a participating or non-participating LaCare Practitioner/Provider. After thirty (30) calendar days, prior authorization requirements apply for those services identified as requiring prior authorization. LaCare will continue to provide coverage for services determined to be medically necessary for an additional sixty (60) calendar days or until the Member may be reasonably transferred without disruption, whichever is less. LaCare will not deny authorization solely on the basis that the Practitioner/Provider is not a participating LaCare Practitioner/Provider.
• Who are in the first trimester of pregnancy and are receiving medically necessary covered prenatal care services the day before becoming a LaCare Member, can continue to receive such medically necessary prenatal care services, including prenatal care, delivery, and postpartum care, without prior authorization and without regard to whether such services are being provided by a participating or non-participating LaCare Practitioner/Provider until such time as LaCare can reasonably transfer the Member to a participating LaCare Practitioner/Provider without impeding service delivery that might be harmful to the Member's health.
• Who are in the second or third trimester of pregnancy and are receiving medically necessary covered prenatal care services the day before becoming a LaCare Member can continue to receive services from their prenatal care Practitioner/Provider (whether a participating or non-participating LaCare Practitioner/Provider) through the postpartum period.

Request Prior Authorization 

To request continuing care services, please call the LaCare Utilization Management Department at 888-913-0350, or send request by fax to 866-397-4522.  Please provide the name of the LaCare member, their LaCare ID number, relevant treatment information such as diagnoses, procedure, office or treatment code.

Claims Filing Instructions

Non-participating providers will be paid 100% of the Louisiana Medicaid Fee Schedule for prior authorized services during the continuity of care period.  Please refer to the LaCare Claims Filing Instructions online at www.lacarelouisiana.com.