Forms & Prior Auth List Notices
Prior Auth Lists, Requirements and Notice of Changes
Prior Authorization Request Forms
- Medical Prior Authorization Request Form
- Molecular Pathology Request Form
- Electronic Claim Fax Cover Sheet
- Prior Authorization for SUD Form
- Prior Authorization for Drug Screening Form
- Authorization to Disclose Health Information to Primary Care Providers
- Continuity of Care Consultation Sheet
- Request for ECT/TMS
- THP Gold Star Program
- Treatment Continuation Request Form
