Forms


LSU First Enrollment Form: GB-01
Medical Claim Form (WebTPA)
Citizens Rx Prescription Drug Claim Form
Citizens Rx Mail Order Prescription Delivery Registration Form
First Choice Provider Nomination Form
Aetna ASA Nomination Form
Medical Necessity Form
WebTPA HIPAA Form
Citizens Rx HIPAA Form

Resources


2019 LSU First Benefit Snapshot
2019 Summary of Benefits
2019 Premiums for Active Employees
2019 Premiums for Retirees
2019 LSU First Preferred Drug List
2019 LSU First Specialty Drug List
2019 LSU First Prior Authorization Drug List
2019 LSU First Drug Exclusion List
Employee Assistance Program
Citizens Rx Diabetic Meter
Guide to WebTPA’s Explanation of Benefits
Proration Guide
EQ Health Care Coordination
Diabetes Monitoring
HIPAA Privacy Practice Effective 1/1/2017
Marketplace Notice
Medicare Part D Notice
Preventative Care Guidelines

LSU FIRST

Claim Support:

1-855-346-LSU1 (5781)

Escalated claim or pharmacy issues? Contact a Member Advocate:

225-906-1280 or 866-607-5325

Member Support:

225-578-8200

LSUFIRST@LSU.EDU

LSUFIRST.WEBTPA.COM

SEARCH FOR PROVIDERS

2019 LSU FIRST PLAN HIGHLIGHTS

Praxis Rx (home delivery pharmacy provider) phone ordering service can be reached at 813-374-6550. For questions about orders, please call 888-903-7453.