Access key forms for authorizations, claims, pharmacy and more.
A copy of the IFSP must be attached to the PA Request.
Transplant Authorization Request Form
Behavioral Health Service Request Form: Applied Behavior Analysis (ABA) For Autism Spectrum Disorder
South Carolina Department of Mental Health CMHC Treatment Review & Authorization Request
Drug Prior Authorization Requests Supplied by the Physician/Facility
Use this form to request a PCP change for a member.
Refund Check Information Sheet* (RCIS)