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Resources and Forms

Provider Reference Guide

• Provider Reference Guide (revised 3/09)

Tools for Filing Claims

Miscellaneous Forms

• Confidential Exchange of Information Form
• Provider Participation Application (click here for more information)
• Member Eligibility & Benefit Verification Form
• LCHP Infant Car Seat Form (English/Spanish)
• LCHP Toddler Car Seat Form (English/Spanish)
• LCHP Boost Car Seat Form (English/Spanish)
• Case Management Referral Form
• Baby Love Referral Form

Clinical Resources
These recommendations are intended as guidelines. They are for the person at average risk and are based on the U.S. Preventive Health Task Force and other professional organizations' recommendations. In some cases, it may be necessary to tailor the recommendations to meet the needs of the patient and their individual situation."

• Preventive Health Guidelines (for Providers)

Questions?

We’re here to help!
You can reach us at 505.727.LOVE or toll free at 800.808.7363.
You can send a fax at 505.727.5303