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L.A. Care Use Only L.A. CARE HEALTH PLAN PRE-AUTHORIZATION REQUEST FORM If the treating physician would like to discuss this case with the physician reviewer or obtain a copy of the criteria used.

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How to fill out the La Care Authorization Form online

Filling out the La Care Authorization Form online can streamline the pre-authorization process for health services. This guide will provide you with clear, step-by-step instructions tailored to help you complete the form accurately and efficiently.

Follow the steps to fill out the La Care Authorization Form online

  1. Press the ‘Get Form’ button to access the La Care Authorization Form and open it in your preferred online editor.
  2. Begin by checking one of the options that applies to the type of request: 'Healthy Families', 'Out-of-network', or 'PPG'.
  3. Enter the patient's information in the designated fields, including their full name, date of birth, member ID or Social Security number, address, and phone number.
  4. Indicate whether the service is In-network or Out-of-network, and select the appropriate urgency category: 'Urgent' (within 72 hours) or 'Routine' (within 5 calendar days).
  5. In the 'Referral - Service Type Requested' section, select the type of service being requested, such as 'DME', 'Home Health', or 'Surgical Procedure', and provide any additional details if necessary.
  6. Fill in the information regarding the requesting provider, including their name, specialty, phone number, address, and fax number.
  7. Next, provide details about the provider who will perform the requested service, including their name, specialty, phone number, address, and fax number.
  8. In the 'Diagnosis/Procedure Information' area, clearly document the necessary codes (ICD-9, CPT, and HCPCS) along with their descriptions.
  9. Provide clinical indications for the request, including pertinent past medical treatments, physical findings, and attach any relevant medical records and test results.
  10. Print your name, sign, and date the form as the requesting provider, ensuring all required fields are appropriately filled.
  11. Finally, review all information for accuracy, then save changes, download, or print the form for submission to L.A. Care UM Department via fax.

Complete your documents online swiftly and easily. Start filling out the La Care Authorization Form now!

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Questions & Answers

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Contact support

To reach L.A. Care for authorization inquiries, you can call their dedicated helpline at 1-888-839-9909. This number can assist you with information regarding the La Care Authorization Form, questions about your benefits, and other preauthorization steps. Having this contact information handy can make your authorization process smoother and more efficient.

Medi-Cal and L.A. Care are not the same, although L.A. Care is a type of Medi-Cal plan. Medi-Cal is California's Medicaid program that provides health coverage to low-income residents, while L.A. Care is a health plan that administers these benefits in Los Angeles County. Understanding the distinction is important for individuals seeking appropriate healthcare solutions, especially when completing documents like the La Care Authorization Form.

An authorization request form is a document used to obtain approval for specific healthcare services or procedures. In the context of L.A. Care, the La Care Authorization Form facilitates this process, ensuring that necessary treatments are covered under your plan. By submitting this form, you help your healthcare provider secure the necessary approvals, which ultimately leads to timely and efficient care.

To complete a prior authorization, you will need the La Care Authorization Form. Start by gathering all necessary patient information, including medical history and the specific treatment or service required. Next, fill out the form with accurate details, ensuring you follow the guidelines provided. Once completed, submit the form to the appropriate insurance provider for review to expedite the approval process.

To submit a prior authorization to Medi-Cal, you need to complete the La Care Authorization Form. This form requires detailed information about the patient, the requested service, and medical necessity. Once completed, you can submit it electronically or via fax, ensuring you keep a copy for your records. For added convenience, consider using uslegalforms to access templates and streamline your submission process.

Filing for prior authorization typically begins with filling out the L.A. Care Authorization Form, which your healthcare provider can help facilitate. Ensure that all relevant patient information, service details, and medical justification are included. Once you have the completed form, submit it directly to L.A. Care via their specified submission channels. Websites like UsLegalForms can simplify this process by providing templates and guidance to help you file accurately.

The preauthorization process for the L.A. Care Authorization Form involves ensuring that your healthcare provider submits the necessary documentation to justify the requested services. This submission is generally reviewed within a specific timeframe. After review, L.A. Care either approves or denies the request based on medical necessity guidelines. For convenience, consider using platforms like UsLegalForms to obtain the necessary paperwork easily.

Fax: 213-438-2201 Use our code look-up tool https://.lacare.org/providers/provider-resources/prior-authorization-search Any questions?

The GHPP is a prior authorization program. This means that a Service Authorization Request (SAR) must be submitted to the GHPP State office for approval for all diagnostic and treatments services, except for emergencies.

Fax W-9 Form (without paper claim) to 213-438-5732.

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© Copyright 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Your Privacy Choices
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
altaFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232