Admissions, Discharges and Transfer Requests

Emergency health services are available and accessible 24 hours a day, seven days a week to provide assistance in coordinating emergency services, higher level of care, and post-stabilization services. You may reach the Utilization Management Health Services Department number at 1-877-431-2273.

To access these services, check member’s eligibility to determine both coverage and provider group/network assignment (e.g. PPG):

  1. Log into the Provider Portal. If you need assistance, please use our Provider Portal Guide.
  2. Check eligibility under “Member Eligibility Verification” tab for the member’s assigned PPG.

    • When checking eligibility, ensure coordination of benefits are verified: Check if member has Part A or Part B as primary, or if there is other health insurance (OHI), as L.A. Care is not always the primary payer and primary for authorizations.

      Sample of Member Eligibility Verification record

       

  3. Identify who is delegated by referring to our Provider Authorization and Billing Reference Guide.
  4. Go to the “Hospital UM Contact Information – Cheat Sheet” for delegated fax numbers.

Delegation Tips:

  • You must check who is delegated to determine who is responsible for review
  • You must check coordination of benefits for primary payer for all services
  • Either PPG or L.A. Care will be responsible for review, depending on assigned PPG
  • L.A. Care Direct Network as assigned PPG requires fax notification to L.A. Care

To request post-stabilization services, call our 24 hour, 7 days a week call center at 1-877-431-2273. Follow the prompts to access post-stabilization.

CSC Health doctors having discussion
Information that will be required
  • Member Name, Date of Birth and ID Number/CIN.
  • Diagnosis
  • Current level of care
  • Age, gender, past medical history, chief complaint, pertinent medical findings, and interventions
  • Vital signs, physical exam, labs, diagnostic, medications
  • Treatment, interventions, response to treatment, plan of care
  • Anticipated discharge disposition

L.A. Care will process your authorization request for post-stabilization care within 30 minutes. The post-stabilization care must be medically necessary. This applies to participating and non-participating providers.  

For additional information, refer to California Health and Safety Code section 1371.4 and Welfare and Institutions Code section 14454, consistent with 42 CFR Section 438.114. Effective May 3, 2023, Medi-Cal providers can also refer to All Plan Letter (APL) 23-009, Authorizations for Post-Stabilization Care Services.

Higher Level of care (HLOC) Acute Inpatient transfer requests

To request higher level of care, CALL our 24 hour, 7 days a week call center at 877-431-2273. Follow the prompts or fax to: 1-213-438-2204.

To request an Acute Inpatient higher level of care or care authorization, do the following:

  • Use our Hospital Priority & Type of Clinical Service Requested Form
    • Fill out Hospital Priority & Type of Clinical Service Requested Form entirely
    • Provide the servicing provider and requesting provider, along with all provider contact information (e.g. name, address, phone, fax)
    • Services that are requested include level of care/codes/Units if applicable
    • Current clinical documentation to support medical necessity
    • Fax to: 1-213-438-2204

Information That Will Be Needed:

  • Transferring MD first and last name & phone number
  • Transferring diagnosis
  • Reason for higher level of care request/ service needed
  • Level of care
  • Pertinent clinicals: Age, gender, past medical history, chief complaint, pertinent findings and interventions, vital signs, physical exam, labs, diagnostic, medications, treatments, interventions, response to treatment plan
L.A. Care requests a fax notification for inpatient admission
  • Notification of Inpatient Admission - fax fact sheet to 1-877-314-4957
  • Inpatient Admission initial clinical documentation and concurrent review clinical documentation
    Fax to: 1-213-438-5063
To request an authorization that is needed to discharge from the acute hospital

This includes a request to discharge to Skilled Nursing Facility

Use our Hospital Priority & Type of Clinical Service Requested Form

  • Fill out Hospital Priority & Type of Clinical Service Requested Form entirely
  • Provide the servicing provider and requesting provider, along with all provider contact information (name, address, phone, fax)
  • Discharge orders or services that are requested include level of care/codes/Units and PASRR results (if applicable)

Current clinical documentation to support medical necessity

  • Fax to: 1-213-438-5066