The Prior Authorization Program is designed to ensure that only medically necessary services are provided in a cost-effective manner. The program also is responsible for ensuring that medically necessary services are not denied to recipients.

Click here to view 10-7-09 Alert regarding additional information for PA reconsiderations

• Prior Review and Authorization Request- Fillable Form 342
  Updated 2-20-08

• Dental Prior Approval - Form 343

• Cochlear Implant Request Form

• Fact Sheet - Coverage of Gastric Bypass Surgery - Updated 6-4-08

• Motorized/Power Wheelchair Assessment Form 384
  Required attachment to Prior Review and Authorization Form 342
   

• Oxygen Therapy Request Form - Form 360

• Pharmacy PA Request Forms

• Provider Manual – Chapter 4
  

• Radiology Management Program

• Hospitals Participating in PT Evaluations

• Update - Delivery Ticket

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