Forms and Resources
Forms
- LSU First Enrollment Form: GB-01
- Medical Claim Form (WebTPA)
- Prescription Drug Claim Form (MedImpact)
- First Choice Provider Nomination Form
- Aetna ASA Provider Nomination Form
- LSU First Prior Authorization Form
- WebTPA HIPAA Form
- MedImpact Rx HIPAA Form
- Certification of Adult Dependent Form
Resources
| General Resources | Annual Notices | 2022 Plan Information |
|---|---|---|
Additional Resources - Medical Claims Administrator and Pharmacy Benefit Manager
LSU First puts access at your fingertips. WebTPA, medical claims administrator, and MedImpact, pharmacy benefit manager, both have secure online portals and mobile apps that allow you to manage your healthcare. Due to HIPAA (Health Insurance Portability and Accountability Act) that protects health information, both portals require that any spouse and/or dependent over age 18 will need to create their own account to view claims information.
WEBTPA
The WebTPA portal allows members to track their HRA, deductible, and out-of-pocket balances, view claims, and print ID cards. You can download their iOS or Android mobile app by searching “WebTPA”.
MEDIMPACT
The MedImpact portal allows members to look on prescription drug coverage, drug costs, compare prices for medications, view medication history, and find an in-network pharmacy. You can download their iOS or Android mobile app by searching “MedImpact”.