- Provider Information
- Behavioral Health Information
- Claims and Member Information
- Claim Reconsideration and Appeals
- Clinical Practice Guidelines
- Cultural Competency Library
- Dental and Vision Information
- Dual Complete (HMO SNP) Program
- Electronic Data Interchange (EDI)
- Provider Administrative Manual
- Provider Forms
- Pharmacy Program
- Provider Training Information
- Reimbursement Policy
You'll find all forms we currently use in the following list.
We're currently reviewing all forms in an effort to make it easier and simpler to work with us, so check back frequently to see what's changed.
- Healthy Louisiana Plan Notification of Pregnancy Form (PDF 116.11 KB) (PDF 205.4 KB)
- Prior Authorization Fax Request Form (PDF 205.4 KB)
- UnitedHealthcare Community Plan Prior Authorization Form (PDF 323.34 KB)
Pediatric Day Health Care Program (PDHC)
The forms below must be used when requesting prior authorization for Pediatric Day Health Care (PDHC) services program by the Louisiana Department of Health (LDH). Contact your Provider Relations Representative with any questions.