...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...

...Form C Cardiac Agents Prior Authorization Request Form Carisoprodol Prior Authorization Request Form Compound Prior Authorization Request Form Cushing’s Syndrome Prior Authorization Request Form Cystic Fibrosis Prior Authorization Request Form...

...Please specify if you believe the request is urgent. Prior Authorization Forms Pharmacy Prior Authorization Request Form Specialty Pharmacy Prior Authorization Form Synagis Prior Authorization Form Hepatitis C Prior Authorization...

...has been revised. See notification dated 07/29/2021. 05/06/2021 Policy Updates May 2021 05/01/2021 New Transportation Vendor 04/30/2021 Prior Authorization Updates 04/28/2021 UPDATE - Prior Authorization Requirements 04/26/2021 National Provider Identifier...

...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 a...

...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...

...service that requires a prior authorization, you must submit a retro-authorization request prior to filing a clinical appeal to our Utilization Review team for consideration. You may submit this online...

...Prior authorization status Member eligibility Coordination of benefits, and more Additional Key Contact Information Below is a list of the plan’s phone numbers for general questions, prior authorizations, claim inquiries...

...– UPDATE 05/05/2025 May 2025 Policy Updates 05/01/2025 Level of Care and Prior Authorization Requirements for Medicaid Covered Nursing Facility (NF) Stays 04/25/2025 Temporary Waiver of Prior Authorization Requirements for...

...Authorization Changes Effective April 1, 2026 03/01/2026 Summary of Formulary/Prior Authorization Changes Effective January 1, 2026 12/01/2025 Summary of Formulary/Prior Authorization Changes Effective October 1, 2025 09/01/2025 Summary of Formulary/Prior...