Prior Authorization (PA) Forms Updated

November 17, 2011

The Initial Authorization Request Form and Cover Sheet Updates or Supporting Documents for Authorizations have been updated. The previous forms will be accepted until November 30, 2011.

The new forms have

  • Space for your fax number and

  • Updated PA service types

These forms are required for requests submitted by fax or mail. The fax number to submit requests has not changed: 1-866-598-3963