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Questions?
Check out your provider manual (PDF). Or call Provider Relations at 1-888-348-2922 (TTY: 711).
Tips for requesting PA
Tips for requesting PA
A request for PA doesn’t guarantee payment. We can’t reimburse you for unauthorized services. You can make requesting PA easier with these tips:
- Register for Availity if you haven’t already.
- Verify member eligibility before providing services.
- Based on the type of request, complete and submit either the physical health PA form (PDF) or the behavioral health PA form (PDF).
- Attach supporting documents when you submit the form. Examples of supporting documents include:
- Current visit notes describing member condition
- Reason services are being requested
How to request PA
You can request PA:
By phone
Ask for PA by calling us at 1-888-348-2922 (TTY: 711).
By fax
Download our PA request form (PDF). Then, fax it to us at 1-866-366-7008.
And be sure to add any supporting materials for the review.