As a PCP, do I need authorization from Peoples Health to perform laboratory services in my office?
All lab work must be sent to our network labs for testing except for certain procedures that you are authorized to perform in your office. For a listing of procedures that you can perform in your office, please refer to the Peoples Health Provider Reference Guide or the Physician Quick Reference Guide. Contact your provider representative if you need more information about performing laboratory services in your office.
Do I need to have services authorized before I perform them?
Certain services and procedures require prior authorization before they can be rendered, and these are listed on the back of the Medical Necessity Form. If you determine that your patient needs one of these services or procedures, you must request prior authorization from Peoples Health to ensure those services will be covered. To request authorization, you must complete and fax a Medical Necessity Form to the Peoples Health Medical Management department at one of the numbers listed on the form before rendering services.
There are some exceptions to this listing, which can be determined by using the Authorization Requirements Search. You can search the database by selecting a place of service code and inputting a CPT code to determine if the procedure requires prior authorization.
Medical Necessity Form
Download Medical Necessity Form – PDF
How do I verify member eligibility and information?
You can send a request to confirm eligibility and information directly from our website or you can call us toll-free at 504-849-4690, 225-346-5705 or toll-free at 1-866-553-5705, Monday through Friday, from 7 a.m. to 4:30 p.m.
What if I have questions about my Explanation of Payment (EOP)?
Please contact us to request an explanation of your EOP.
What if I need forms and/or other documents?
If you need additional forms or other documents, you can either download them from the Provider Plan Documents and Forms page or you can call your provider representative to receive printed copies.
What lab facility should I use?
You must use network lab providers for all laboratory services, unless it is otherwise noted in your Provider Reference Guide that you can perform the laboratory service in your office or at your facility. Please refer all Peoples Health plan members to Quest Diagnostics or the nearest network lab provider in your area. Use the Other Provider Search tool to find a listing of network lab providers in your area.
What if I can't get in touch with my provider representative?
If you cannot reach your provider representative, you may contact Dee Duhe-Robichaux, provider relations manager, at 504-681-8837.
How do I know which physician team the member is in?
To find out which physician team the member is in, you can call us at 504-849-4690, 25-346-5705 or toll-free 1-800-553-5705, Monday through Friday, from 7 a.m. to 4:30 p.m.
What do I do in the event of an emergency?
A disaster can damage your ability to conduct your practice. Peoples Health requests that you complete our Evacuation Communication Information form to help ensure that we can maintain contact with you in the event of an emergency. You can download the form below and return it via fax to your provider representative at 504-849-6916.
Evacuation Communication Information Form
Download Evacuation Communication Information Form – PDF
As an out-of-network provider, can I treat Peoples Health patients?
Most 2021 Peoples Health plans require that plan members receive care from network providers, except in emergency or urgent situations; however, the following plans do offer an out-of-network benefit that allows enrolled members to receive other services from out-of-network providers. Members may pay higher costs for out-of-network services.
For services requiring authorization, you must obtain prior authorization from Peoples Health before rendering the service. Complete a Medical Necessity Form, and fax the form and any supporting documentation to one of the numbers on the form.
To verify patient eligibility, contact the provider services department at 1-877-346-5703, Monday through Friday, from 8 a.m. to 5 p.m. You will need to provide the plan name and member ID number, which you can find on the front of the patient’s Peoples Health ID card.
For more information, visit Information for Out of Network Providers.