Q: As a PCP, do I need authorization from Peoples Health to perform laboratory services in my office?

A: All lab work must be sent to Quest Diagnostics 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.

Q: As a specialist, do I need to have services authorized before I perform them?

A: 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

Q: How do I verify member eligibility and information?

A: You can send a request to confirm eligibility and information directly from our website or you can call us toll-free at 1-866-553-5705, seven days a week, from 7 a.m. to 9 p.m. If you contact us on a weekend or holiday, you may need to leave a message, but we will return your call within one business day.

Q: What if I have questions about my Explanation of Payment (EOP)?

A: Please contact us to request an explanation of your EOP.

Q: How often are the Referral Guides updated? How can I get a copy?

A: Referral Guides, which include the names, phone numbers and addresses of the physician providers in each physician team, are updated on a monthly basis. Your Provider Relations representative will deliver an updated copy to you for the physician team(s) in which you participate.

Q: What if I need forms and/or other documents?

A: If you need additional forms or other documents, you can either download them from the Plan Documents and Forms page or you can call your provider representative to receive printed copies.

Q: What lab facility should I use?

A: The Peoples Health network lab provider is Quest Diagnostics 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

Q: What if I can't get in touch with my provider representative?

A: If you cannot reach your provider representative, you may contact Patrick Murphy, Provider Relations Manager, at 504-681-8808.

Q: How do I know which physician team the member is in?

A: To find out which physician team the member is in, you can look on their plan ID card or call Peoples Health Member Services toll-free at 1-800-553-5705, seven days a week, from 7 a.m. to 9 p.m. TTY users may call 711. If you contact us on a weekend or on a holiday, you may need to leave a message, but we will return your call within one business day.

Q: 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