Lagniappe Advantage providers can find secure access to claims, eligibility info, authorizations, view
patient history, submit an authorization request and more.
Authorizations and Referrals
Some medical services and medications require prior authorization (also called “pre-approval”) before they are covered. This process ensures that the care you receive is medically necessary, evidence-based, and appropriate for your condition.
- PQI Referral Form
- Services that Require Prior Authorization
- Concurrent SNF Faxback Form
- Part B Therapy Request form
- DME Auth Form
- Inpatient Auth Form
- Part B Medication Auth Form
- Preservices Auth Form
- SNF Skill-in-Place Auth Form
- Wound Care Auth Form
Clinical Determination and Medical Necessity Criteria
Utilization Management decisions are based on nationally recognized medical necessity criteria and clinical evidence. These criteria help determine whether a requested service, treatment, or level of care is appropriate and meets plan requirements.
View Clinical Determination and Medical Necessity Criteria Here ›
Clinical Practice Guidelines
Our clinical practice guidelines support high-quality, consistent care by outlining evidence-based standards used in medical decision-making. Providers may review these guidelines to understand how certain services are evaluated during authorization review.
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CMS ID Number: H6566_Website,Last modified: December 15, 2025