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It outlines covered Medi-Cal benefits, referral and prior authorization steps for services such as CBAS, LTC, IHSS, and MSSP, and clarifies provider responsibilities and authorization workflows. The guide also describes how the Provider Portal supports reporting and how care management coordinates support across risk levels and complex needs.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/la4163-0225-contracted-provider-reference-guide/640739/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/la4163-0225-contracted-provider-reference-guide/640739.png","ImageObject",300,407,{"name":92,"@type":93},"Aditya","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-08","2026-10-22",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the purpose of the LA Care Direct Network contracted provider network?","Question",{"text":112,"@type":113},"It aims to enhance Medi-Cal member access to care, enable direct relationships with Los Angeles County providers, support continuity of care through the selected PCP, and reduce complexity while improving health outcomes through closer participation.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How do PCPs handle referrals and prior authorizations for CBAS and LTC?",{"text":117,"@type":113},"PCPs must complete a written order and fax the completed CBAS or LTC authorization request form with the physician order to the appropriate number. CBAS and LTC authorizations are managed by LA Care’s Utilization Management department.",{"name":119,"@type":110,"acceptedAnswer":120},"What are key provider responsibilities for IHSS and how do members get help?",{"text":121,"@type":113},"Providers must complete the IHSS Health Care Certification form (SOC 873). 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Care Direct Network  \n TOC  \nWelcome Participating Contracted Provider  \nL.A. Care Health Plan’s (L.A. Care’s) first directly contracted provider network aims to:  \n Enhance Medi-Cal Members’ ability to access care  \n Allow Los Angeles County Providers the ability to have a direct relationship with L.A. Care  \n Assure Member’s continuity of care with Provider of choice  \n Reduce the complexity of serving Medi-Cal Members and increasing healthy outcomes through closer relationships with participating providers directly  \nAs a provider contracted to participate in the exclusive closed subnetwork within L.A. Care’s Medi-Cal Provider Network, please be aware that our members may be assigned to, or can always choose a Primary Care Physician (PCP) within L.A. Care’s Direct Network in accordance with the member assignment and PCP change rules outlined in the Medi-Cal Member Handbook Evidence of Coverage. Medi-Cal Members will receive primary care from their PCPs who then will coordinate all specialty services from physicians, facilities, hospitals, and other network providers contracted in the Direct Network. Contracted PCPs will receive monthly membership reports identifying each member assigned to the PCP/Group available for view and download on the Provider Portal.  \nMember ID Card Example:  \nHelpful Resources  \nTo view a list of helpful resources, please refer to the Resources at a Glance section in this guide. There you would find contact information, forms, and more.  \nCovered Medi-Cal Benefits  \nPlan Benefits | Reference Guide  TOC  \nAll covered benefits are free to the Member:  \n Doctor visits  \n Dental and Mental Health Services*  \n Vision Care  \n Hospital care and emergency room care  \n Prescription drugs (covered by Medi-Cal Rx, a Medi-Cal FFS program), shots (immunizations), and more  \n* Dental services and specialty mental health services are carved out from L.A. Care required benefits. However, Topical Fluoride Varnish is not part of the Dental carve out. Topical Fluoride Varnish is included in the Early and Periodic Screening, Diagnostic and Treatment Medi-Cal benefit.  \nTo learn more about covered Medi-Cal benefits visit https://www.lacare.org/health-plans/medi-cal/benefits-guide  \nCommunity Based Adult Services (CBAS)  \nFor information on CBAS, please refer to Chapter 17 of the Universal Provider Manual (UPM) .  \nLong Term Care (LTC)  \nFor information on LTC, please refer to Chapter 17 of the Universal Provider Manual (UPM) .  \nReferrals for CBAS & LTC  \n PCP needs to complete a written order.  \n Fax the completed CBAS or LTC authorization request form with the physician order to the appropriate number.  \n All Authorization Forms are available at [https://www.lacare.org/priorauth](https://www.lacare.org/priorauth)  \n CBAS and LTC Authorizations are managed by L.A. Care’s Utilization Management department.  \nIn Home Supportive Services (IHSS)  \nFor information on IHSS, please refer to Chapter 17 of the Universal Provider Manual (UPM) .  \nThe Managed Long Term Services and Supports (MLTSS) Department Assists Members with IHSS by:  \n Coordinating the assessment and re-assessment process  \n Initiation of t","cbCaifQRtFlSkl2r","https://ap.wps.com/l/cbCaifQRtFlSkl2r","pdf",2296065,49,"English","# Welcome Participating Contracted Provider\n## Welcome to L.A. Care Direct Network\n# Covered Medi-Cal Benefits\n## Plan Benefits\n# Referrals and Prior Authorizations\n## Referrals for CBAS & LTC\n## In Home Supportive Services (IHSS)\n## Multipurpose Senior Services Program (MSSP)\n# Provider Portal\n# Claims & Reimbursement\n# Resources at a Glance","[{\"question\":\"What is the purpose of the LA Care Direct Network contracted provider network?\",\"answer\":\"It aims to enhance Medi-Cal member access to care, enable direct relationships with Los Angeles County providers, support continuity of care through the selected PCP, and reduce complexity while improving health outcomes through closer participation.\"},{\"question\":\"How do PCPs handle referrals and prior authorizations for CBAS and LTC?\",\"answer\":\"PCPs must complete a written order and fax the completed CBAS or LTC authorization request form with the physician order to the appropriate number. CBAS and LTC authorizations are managed by LA Care’s Utilization Management department.\"},{\"question\":\"What are key provider responsibilities for IHSS and how do members get help?\",\"answer\":\"Providers must complete the IHSS Health Care Certification form (SOC 873). Members needing IHSS can be referred directly to the DPSS IHSS Application Line or to LA Care’s MLTSS Department for assistance.\"}]","LA4163 - 02/25 - Contracted Provider Reference Guide | PDF",1792711282,123]