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Prior Authorizations

CAUTION: Please be sure to select the correct fax number on the Authorization Form for your county/service area. Use of an incorrect fax number may cause unnecessary delays in getting your authorization request to the appropriate medical review team.

Please remember that patient confidentiality and privacy is protected under HIPAA, so using the correct form and fax number will ensure to protect you against inappropriate disclosures.

Prior Authorization Requirements

Medical Prior Authorization

Pharmacy Prior Authorization

You can submit an Online Coverage Determination, or use the form below: