Download the provider recommendation template here.
Some of your clients are eligible for 9 additional Perinatal, Postpartum visits with a provider recommendation.
In general, all clients with Medi-Cal plans are eligible for these additional postpartum visits. Only some Commercial plans include these additional visits in their coverage. We indicate whether this client is eligible for these additional services on their Client Profile.
How to determine your client's eligibility
Go to the client's Client Profile
Look on the lefthand sidebar in the boxed section that is labeled Pregnancy
Under the Additional Postpartum heading check to see if the client has the Upload recommendation link.
If the Upload recommendation link is visible, that means the client is eligible.
If the Upload recommendation link is hidden, you will see a message explaining to you why this client is not eligible.
Obtaining a provider recommendation
A provider recommendation is a written document from a licensed medical professional that recommends the client for additional doula services.
For the doula benefit, Medi-Cal defines a “licensed provider” as a physician or other licensed practitioner of the healing arts, including nurse midwives, nurse practitioners, licensed midwives, and behavioral health providers, acting within their scope of practice under state law. The recommending licensed provider does not need to be enrolled in Medi-Cal or be a network provider within the beneficiary’s managed care plan.
The recommendation can be in any written format as long as it includes a note recommending the client for additional postpartum services and the following information:
Client's First Name, Middle Name, Last Name
Client's Date of Birth
Licensed Provider's NPI Number
Licensed Provider's First Name, Middle Name, Last Name
Date of Recommendation
Licensed Provider's Signature
Download the provider recommendation template here.
Uploading the provider recommendation on the Loula Portal
Obtain a provider recommendation from the client. Learn more about how to do that in the section above.
Make sure the provider recommendation is in a valid digital format. For example, you might scan the document and save it as a PDF, or you might take a photo of the recommendation and save it as a JPG or PNG. Make sure all writing is legible in this digital copy!
In the client's Client Profile, click the Upload Recommendation link in the Pregnancy.
On desktop, find the Pregnancy section on the Client Information sidebar on the left
On mobile, find the Pregnancy section under the Client Information tab
Follow the instructions on the modal that appears to to upload the recommendation.
Click Submit when you are ready to submit the recommendation for review.
Once you submit the recommendation, your recommendation will be marked as Under Review.
What happens after I upload the recommendation?
Our team will review the upload to ensure it’s a valid recommendation. We will give you an update on your recommendation within 3 business days via email.
If your recommendation is approved, the recommendation status will be marked as Approved. Your visit count for Perinatal visits will also be updated accordingly.
If your recommendation is not approved, we will email you explaining to you why it was not approved. You may delete the original recommendation and upload a new recommendation, or if you believe we have made this determination in error, you may send a note explaining why.
How additional postpartum visits affect your visit count
These 9 additional visits are for the Perinatal, Postpartum visit type, not to be confused with the Postpartum, Extended visit type. In addition to these 9 additional Perinatal, Postpartum visits, you still have access to the 2 Postpartum, Extended visits each client is automatically eligible for.
All clients automatically have 8 Perinatal visits that can be used across both Perinatal, Prenatal or Perinatal, Postpartum visit types.
Once your client has been approved additional postpartum visits with a provider recommendation, these 9 additional visits are added to the Perinatal visit count in the Client Profile.
Let's run through some scenarios to explain how these additional visits impact your client's visit count.
Example One: You have 3 Perinatal, Prenatal visits for a client.
Then, you obtained a provider recommendation and we have approved the recommendation.
The client has now delivered and is postpartum.
That means you can do up to 15 Perinatal, Postpartum visits for this client (the 5 remaining Perinatal visits your client had originally + the 9 additional Perinatal, Postpartum visits the client has been approved for).
Example Two: You have obtained a provider recommendation up front, recommending the client for additional postpartum services. You and the client the client decide to use all 8 of their original Perinatal visits on Perinatal, Prenatal visits.
The client would have access still after delivery to the additional 9 Perinatal, Postpartum visits.
Postpartum services may be provided up to 1 year after the client's pregnancy end date (i.e. the date of delivery)