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Contracting and Practice Changes

Member-Related Forms

Pharmacy Prior Authorization

In accordance with West Virginia Senate Bill 267, all prior authorization requests must be submitted electronically effective Jan. 1, 2024.

Prior authorization requests for physician administered drugs (billed under medical benefit) can be submitted electronically via the CareSource Provider Portal (See Providers, then Prior Authorization and Notifications, then Physician Administered Pharmacy Codes).

Prior authorization requests for pharmacy benefit administered medications can be submitted electronically via the SureScripts or CoverMyMeds Portals.

NOTE: All oncology medication treatment regimen requests must be submitted and reviewed through the EVITI Connect Portal.

Medical Prior Authorization


Disputes & Appeals

Fraud, Waste and Abuse