Manuals and Forms
Provider Manuals
To help you better understand our guidelines, policies and procedures, L.A Care issues a manual to its providers each year. You can review a PDF version by selecting the appropriate manual on the Resources links.
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.
Prior Authorization Request Forms
Difficult Placement Authorization Request Form
Higher Level of Care (HLOC) Authorization Form
Hospital UM Contact Information (Authorization Contact Cheat Sheet)
SNF UM Contact Information (Authorization Contact Cheat Sheet)
SNF Authorization and Billing Guidance
Provider Authorization and Billing Reference Guide
Medi-Cal Shared Risk Amendment Template
Physician Certification Statement (PCS) form
Preferred Language Labels (Sized for Avery 5160)
Interpretation Request/Refusal Labels (Sized for Avery 5160)
ELDA Technical Bulletin
Coding Reference Guide for Acute Respiratory Conditions
Provider Authorization and Billing Reference Guide
Medi-Cal Shared Risk Amendment Template
SNF Authorization and Billing Guidance
Hospital UM Related Fax Information for All L.A. Care Members
SNF Related Fax Information for All L.A. Care Members