Provider Toolkit: Prior Authorization Guide

How to Secure Prior Authorization

Pre-Auth Needed Tool

Use the Pre-Auth Needed Tool on Ambetter.LouisianaHealthConnect.com to quickly determine if a service or procedure requires prior authorization.

Submit Prior Authorization

If a service requires authorization, submit via one of the following ways:


SECURE WEB PORTAL
Provider Portal
This is the preferred and fastest method.


PHONE
1-833-635-0450
After normal business hours and on holidays, calls are directed to the plan’s 24-hour nurse advice line. Notification of authorization will be returned by phone, fax or web.


FAX

  • Medical Prior Authorization Fax: 833-603-2871
  • Medical Inpatient Admissions Fax: 833-751-2724
  • Medical Concurrent Review Fax: 833-751-2721
  • Behavioral Health Inpatient Fax: 833-792-2721
  • Better Health Outpatient Fax: 833-792-2720
  • High Tech Imaging: RadMD.com
  • Rehabilitation Services and Pain Management: RadMD.com
  • Pharmacy - Envolve Pharmacy Solutions prior authorization can be accessed at https://pharmacy.envolvehealth.com/pharmacists.html under the "CoverMyMeds" link

Timeframes for Prior Authorization Requests and Notifications

The following timeframes are required of the ordering provider for prior authorization and notification:

Service Type Timeframe
Schedule admissions 5 business days prior
Elective outpatient services 5 business days prior
Emergent inpatient admissions 1 business day
Observation - 48 hours or less 1 business day for non-participating providers
Observation - greater than 48 hours 1 business day
Maternity admissions 1 business day
Newborn admissions 1 business day
Neonatal Intensive Care Unit (NICU) admissions 1 business day
Outpatient Dialysis 1 business day
Organ transplant initial evaluation 30 days prior
Clinical trials services 30 days prior

 

See below for a list of services that require prior authorization.

 

Please note:

  1. Emergency services DO NOT require prior authorization.
  2. All out-of-network services and providers DO require prior authorization.
  3. Failure to complete the required authorization or notification may result in a denied claim.

Services and Procedures Requiring Prior Authorization

THE FOLLOWING LIST IS NOT ALL-INCLUSIVE

Ancillary Services

Procedures/Services

Inpatient Admissions

  • Air ambulance transport (non-emergent fixed wing airplane)
  • Durable Medical Equipment (DME)
  • Home healthcare services
  • Hospice
  • Furnished medical supplies
  • Orthotics/prosthetics
  • Genetic testing
  • Quantitative urine drug screen
  • Outpatient Physical, SPeech and Occupational therapy administered by NIA*
  • Experimental or investigational
  • High Tech Imaging administered by NIA
  • Cardiac and respiratory therapy
  • Observation stays exceeding 48 hours 
    • Notification is required within 1 business day if admitted
  • Transplants
  • Partial inpatient, PRTF and/or intensive outpatient programs

*Effective for dates of service on or after January 1, 2022


LOG INTO OUR SECURE WEB PORTAL

Provider Portal

Out-of-Network Services

All out-of-network services and providers require prior authorization, excluding emergency services.