Prior Authorization

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.

• Prior Authorization Forms
• Provider Manual - Chapter 4 - Obtaining Prior Authorization
• Hospitals Participating in PT Evaluations
• Obstetrical (OB) Ultrasound Requests for Prior Authorization - FAQs - 12/9/16
• Cardiology Prior Authorization - For Prior Approval of Nuclear Cardiology, Diagnostic Heart Catherization, Stress Echocardiography, Transesophageal, Echocardiography and Transthoracic Echocardiography
• Radiology Management - For Prior Approval of CTA scans, CT scans, PET scans, MRAs and MRIs

• Wheelchair/Seating Evaluation Form 384 - Required attachment for Form 342
• Wheelchair Modification/Repair Form 386