Providers

• Training
  • Schedule an Orientation in Your Office
• Resources
  • Interpretation Services
  • Member Rights and Responsibilities
  • NaviNet
  • PCP Auto Assignment
  • Prior Authorization
  • Provider Claims Update
  • Provider Directory
  • Provider Forms
  • Provider Grievances
  • Provider Handbook
  • Provider Marketing Guidelines
  • Provider Reference Guide
  • Referrals
• Billing
  • Billing Manual
  • Durable Medical Equipment Fee Schedule
  • 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
  • LaCare Provider Letters

Provider Grievances

Provider Complaints and Claims Disputes

• Informal Disputes

• Formal Provider Disputes Process

• Common Reasons for Claim Rejections & Denials

Appeals regarding Medical Necessity

• Provider Medical Necessity Appeals

• First Level Appeal Review

• Second Level Appeal Review

Member Grievance and Appeal Process

• Member Grievance and Appeal Process

• Member Appeal Procedures

• Fair Hearing Procedures