Resources
- Account executives (PDF)
- Account executives map (PDF)
- Complaints, disputes, and appeals
- Credentialing
- Disclosure of Ownership and Controlling Interest Statement for Entity/Business (PDF)
- Disclosure of Ownership and Controlling Interest Statement for Individuals (PDF)
- Electronic funds, remittance, and data interchange
- Quality performance specialist map (PDF)
- Adverse incident reporting (PDF)
- Primary care provider reassignment guidelines (PDF)
- Provider complaint and dispute processing and resolution policy (PDF)
- Continuity for behavioral healthcare & care coordination with primary care and behavioral health providers (PDF)
- Continuity of care (PDF)
- AmeriHealth Caritas Louisiana enrollee PCP reassignment dispute process (PDF)
- Performance quality monitoring plan (PDF)
- Bright Futures periodicity schedule (EPSDT) (PDF)
- Clinical policies
- Clinical practice guidelines (PDF)
- Flu information
- Healthcare professional guidelines for comprehensive diagnostic evaluations for ABA services (PDF)
- Hepatitis C algorithm (PDF)
- Hepatitis C guidance (PDF)
- InterQual criteria
- Long Acting Reversible Contraceptives (LARCs) Billing and Ordering Guide (PDF)
- Opioid overdose prevention
- Sickle cell disease resources for providers (PDF)
- Women's health
- ADHD toolkit
- ASAM benzodiazepine tapering guidelines
- Behavioral health provider reference guide (PDF)
- Behavioral health provider toolkit (PDF)
- Cancer screening provider toolkit (PDF)
- Claim filing instructions (PDF)
- EPSDT provider toolkit (PDF)
- Fluoride varnish provider toolkit (PDF)
- HEDIS tip sheet: Follow-up after emergency department visit (FUM)(PDF) — for mental illness
- HEDIS tip sheet: Follow-up after emergency department visit (FUA)(PDF) — for substance use
- HEDIS tip sheet: Follow-up after hospitalization (FUH)(PDF) — for mental illness
- HEDIS playbook (PDF)
- HEDIS tip sheet: Timeliness of Prenatal Care (PDF)
- HEDIS tip sheet: Postpartum Care (PDF)
- HEDIS tip sheet: Prenatal Depression Screening and Follow-Up (PND-E) (PDF)
- HEDIS tip sheet: Postpartum Depression Screening and Follow-Up (PDS-E) (PDF)
- How to Navigate Louisiana's Complex Systems to Find the Supports and Services That You Need (PDF)
- Marketing guidelines
- NantHealth/Navinet: How to Inquire About an Authorization
- NaviNet Basics Provider User Guide (PDF)
- Provider handbook
- Provider manual updates (PDF)
- Provider reference guide (PDF)
- Reducing Disparities in the Management of Hypertension (PDF) in African American Patients
- Sexually Transmitted Infections (STI) provider toolkit (PDF)
- TeleECHO™ Integrated Health Care Clinic Participant Guide (PDF)
- Care at Home — In Lieu of Policy (PDF)
- Chiropractic Services for Adults — In Lieu of Policy (PDF)
- Home Delivered Meals — In Lieu of Policy (PDF)
- Hospital-Based Care Coordination of Pregnant and Postpartum Individuals with Substance Use Disorder (SUD) and Newborns — In Lieu of Policy (PDF)
- Mental Health Intensive Outpatient (MH-IOP) — In Lieu of Policy (PDF)
- Outpatient Lactation Support — In Lieu of Policy (PDF)
- Remote Patient Monitoring — In Lieu of Policy (PDF)
- Assessment of new and emerging medical treatments and technology (PDF)
- Concurrent review (PDF)
- Member transition of care continuity of care (PDF)
- Covered benefits and services (PDF)
- Prior authorization of non-participating providers (PDF)
- Post-service review (PDF)
- Decision response time (PDF)
- Standard & Expedited Prior Authorization of Services (PDF)