Prior Authorizations
Prior Authorization Requirements
Provider Portal
Does your code require prior authorization? Access our provider portal to begin your request.
Prior Authorization Request Forms
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Medical Prior Authorization Request Form
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Molecular Pathology Request Form
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Electronic Claim Fax Cover Sheet
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Prior Authorization for SUD Form
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Prior Authorization for Drug Screening Form
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Pharmacy Pre-Authorization and Notification Form
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Authorization to Disclose Health Information to Primary Care Providers
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Continuity of Care Consultation Sheet
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Request for ECT/TMS
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Treatment Continuation Request Form