Manuals and Forms

Universal Provider Manual

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L.A. Care offers its providers a Universal Provider Manual (UPM). The UPM serves to support our providers by helping you better understand our guidelines, policies and procedures, and to comply with applicable laws, rules, regulations, guidance, and accreditation standards.

Universal Provider Manual + D-SNP Chapter, Effective 01/01/24

Provider Forms

 

Below are the most frequently requested forms for L.A. Care Providers. If you have a suggestion for how we can improve any of the available forms, please contact Provider Support.

Case Management Forms
Disease Management Forms
Employee Language Skills Self-Assessment Form
Initial Health Assessment Forms
Interpreter Poster
Member Demographic Data Report
Patient Interpreter Services Labels

Preferred Language Labels (Sized for Avery 5160)
Interpretation Request/Refusal Labels (Sized for Avery 5160)

Pharmacy and Formulary Forms

MedWatch Form

L.A. Care Medicare Plus (HMO-DSNP):
Quality Drug Clinical Care Form
Quality Drug Clinical Care Form (Spanish)

L.A. Care Covered/Direct & Homecare Workers Health Care Plan:

Postal Prescription Services Form
Postal Prescription Services Form (Spanish)

Visit our Pharmacy Services web page for more information.

Prescription Drug Prior Authorization Request Forms
Provider Portal Resources

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