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