...Authorization Request Form Specialty Pharmacy Prior Authorization Form Spinal Muscular Atrophy (SMA) Prior Authorization Provider Form T Testosterone Prior Auth Form Request Form Topical Agent Prior Authorization Request Form Tzield...

...The following is a list of available Prior Authorizations Forms: ABA Prior Authorization Form CES Waiver Prior Authorization Form Community Based/Behavioral Health Outpatient Prior Authorization Form EIDT/ADDT and ST/PT/OT Prior...

...Formulary (Last updated 12/01/2025) Prior Authorization Criteria 2026 Medicare Part D prior authorization Criteria Last updated on 10/15/2025 2025 Medicare Part D prior authorization Criteria Last updated on 12/01/2025 Step...

...Member Consent/HIPAA Authorization Form – Online Member Consent/HIPAA Authorization Form - Hard copy Fraud Waste and Abuse Reporting Form – Use this form if you think a health partner or...

...most up-to-date information, access the online Formulary Search Tool. Helpful Online Drug Formulary Tools Fingertip Formulary Formulary Search Tool Pharmacy Page Download this medical application to your mobile device for...

...6/07/2022 12/22/2022 Synagis Prior Authorization Resources Notification 12/19/2022 Prior Authorization Requirement for Non-Participating Laboratory Services 12/13/2022 Pharmacy Policy Updates - January 2023 12/09/2022 Unified Preferred Drug List (UPDL) Changes 12/07/2022...

...the CareSource Utilization Management Department for a service that requires a prior authorization, you must submit a retro-authorization request to the CareSource Utilization Management department prior to filing a clinical...

...authorization. Although your provider should get a prior authorization from us, you may want to ensure that your provider has received our approved prior authorization. Many other services do not...

...of Representative form or the Internal Appeal Request form. Return the completed form to us along with your grievance, appeal, or request for an external review. These forms are available...

...Just call Member Services at 1-833-230-2005 (TDD/TTY: 711) Monday through Friday, 8 a.m. to 5 p.m. CT. You can also contact us online through the Tell Us form. What if...