New Prior Authorization Request Forms

Effective July 1, 2017, there will be two new Prior Authorization Request Forms posted in the Prior Authorization Section of the Medicaid website. The following forms will be posted and are required after October 1, 2017. The general Request for Prior Authorization Form should only be used when there is not a specific form for the service(s) being requested. The new forms are Request for Prior Authorization and Genetic Testing Prior Authorization Request Form. Requests received after October 1, 2017, that have been submitted using an outdated or inappropriate request form will be returned. The PA request must be sent with complete documentation or the request will be returned with a letter indicating what is missing. The date in which a complete request, with all necessary supporting documentation, is received will be the date posted for the PA request. This includes using a current prior authorization request form. All requests must be submitted to the correct fax number listed on the form or in the instructions that are attached to the specific form.


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