Continuity of Care for Participating and Non-Participating Providers

AmeriHealth Caritas Louisiana provides continuing coverage of care for newly enrolled members who are engaged in an ongoing course of treatment with a participating or non-participating provider to promote continuity of care in the following situations:

Newly enrolled members

• Who are receiving medically necessary covered services the day before becoming an AmeriHealth Caritas Louisiana member, can continue to receive such medically necessary services for the first thirty (30) calendar days of enrollment without prior authorization and without regard to whether such services are being provided by a participating or non-participating AmeriHealth Caritas Louisiana provider. After thirty (30) calendar days, prior authorization requirements apply for those services identified as requiring prior authorization. AmeriHealth Caritas Louisiana will continue to provide coverage for services determined to be medically necessary for an additional sixty (60) calendar days or until the member may be reasonably transferred without disruption, whichever is less. AmeriHealth Caritas Louisiana will not deny authorization solely on the basis that the provider is not a participating AmeriHealth Caritas Louisiana provider.

Newly enrolled pregnant members

• Who are receiving medically necessary covered services in addition to, or other than, prenatal services (see below for newly enrolled pregnant members receiving only prenatal services) the day before becoming an AmeriHealth Caritas Louisiana member can continue to receive such medically necessary services for the first thirty (30) calendar days of enrollment, without prior authorization and without regard to whether such services are being provided by a participating or non-participating AmeriHealth Caritas Louisiana provider. After thirty (30) calendar days, prior authorization requirements apply for those services identified as requiring prior authorization. AmeriHealth Caritas Louisiana will continue to provide coverage for services determined to be medically necessary for an additional sixty (60) calendar days or until the member may be reasonably transferred without disruption, whichever is less. AmeriHealth Caritas Louisiana will not deny authorization solely on the basis that the provider is not a participating AmeriHealth Caritas Louisiana provider.
• Who are in the first trimester of pregnancy and are receiving medically necessary covered prenatal care services the day before becoming an AmeriHealth Caritas Louisiana member can continue to receive such medically necessary pregnancy-related services, including prenatal care, delivery, and postpartum care, without prior authorization and without regard to whether such services are being provided by a participating or non-participating AmeriHealth Caritas Louisiana provider until such time as AmeriHealth Caritas Louisiana can reasonably transfer the member to a participating AmeriHealth Caritas Louisiana provider without a delay in service delivery that might be harmful to the member's health.
• Who are in the second or third trimester of pregnancy and are receiving medically necessary covered prenatal care services the day before becoming an AmeriHealth Caritas Louisiana member can continue to receive services from their prenatal care provider (whether a participating or non-participating AmeriHealth Caritas Louisiana provider) through the postpartum period.

Request prior authorization 

To request continuing care services, please call the AmeriHealth Caritas Louisiana Utilization Management department at 1-888-913-0350 or send request by fax to 1-866-397-4522.  Please provide the name of the AmeriHealth Caritas Louisiana member, their AmeriHealth Caritas Louisiana ID number, relevant treatment information such as diagnoses, procedure, office, or treatment code.

Claims filing instructions

Non-participating providers will be paid 100% of the Louisiana Medicaid fee schedule for prior authorized services during the continuity of care period.  Please refer to the AmeriHealth Caritas Louisiana claim filing instructions (PDF).