Open Monday–Friday 8 a.m.–5 p.m.
You may have to submit a provider-specific form, such as an invoice, along with any required documentation. Please check Subchapter 5 of your provider manual for specific requirements.
You can submit a prior authorization request through the POSC (link above).
To submit a paper prior authorization request:
1. Download the PA-1 request form.
PDF: Prior Authorization Request [PA-1]
Word: Prior Authorization Request [PA-1]
2. Mail the completed prior authorization request form and attachments to the address listed on the form.
Approve the request: we authorized the request.
Deny the request: we denied the request and won’t reimburse for the service.
Modify the request: we approve a service that is different in quantity or nature than your request. We determined that the approved item is appropriate to meet the medical needs of the member.
Defer the request: we need more information to make a decision. We ask you to submit supporting documentation.
If we defer a prior authorization request, we send notification to both you and the member explaining why. The most common reason for deferral is missing documentation. You can submit the needed information within 30 days, either by attaching it to the online prior authorization request or by mail. When we receive the required information, our review can continue.
If we modify or deny a prior authorization request, the member has a right to appeal the decision.
Open Monday–Friday 8 a.m.–5 p.m.
