Summary
L.A. Care Health Plan issued a reminder policy emphasizing Enhanced Care Management (ECM) eligibility screening and prior authorization best practices for L.A. Care members. The policy clarifies that DME prior authorization requests should originate from contracted DME suppliers (not ordering providers) to ensure accurate codes and quantities, and introduces in-home assessments via Periscope for complex DME requests exceeding $5,000 or with access concerns.
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What to do
Action · 6 steps
01Immediately effective (August 3, 2026).
02Billing and clinical staff must update DME prior authorization workflow to direct all requests through contracted DME suppliers (e.g., Western Drug at https://www.westerndrug.com/) rather than submitting from the ordering provider.
03Providers must include complete clinical documentation (written orders, prescriptions, history, physical exam findings, treatment plan, progress notes) with all prior authorization submissions to prevent delays and secondary authorization requests.
04When ordering DME items with anticipated costs >$5,000 or where member access/usability is unclear, providers should anticipate L.A.
05Care will coordinate in-home assessments through Periscope and plan accordingly for extended review timelines.
06Front-desk and billing staff should refer eligible members (experiencing homelessness, frequent ED/hospital admissions, serious mental health/substance use disorder, high-risk pregnancy, recent incarceration, long-term care risk, or recent SNF discharge) to ECM team at (844) 200-0104 or ECMMembership@lacare.org.
If missed: Failure to route DME requests through contracted suppliers will result in incomplete authorizations requiring resubmission and delayed member equipment delivery.
Original notice
Available Resources and Reminders
lacare.org · Always check the source before changing claims.