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Provider Forms

 

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.

Forms 

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.