Access key forms for authorizations, claims, pharmacy and more.
This request will be treated as per the standard organization determination time frames.
Drug Prior Authorization Requests Supplied by the Physician/Facility
A fillable form documenting behavioral health areas of specialization
Contains key phone numbers and information on claims, appeals and more.
Refund Check Information Sheet* (RCIS)
Fill out and submit this form to request prior authorization (PA) for your Medicare prescriptions.
Fill out and submit this form to request an appeal for Medicare medications.