Providers for CMS T21

Prior Authorization Guidelines

Prior Authorization requests require the submission of supporting clinical documentation for medical review. Failure to provide clinical documentation may result in a delay/denial of the request.

For a list of services and equipment requiring authorizations, click here

To Request Authorization, please Fax to: (844) 806-0397
For a CMS Prior Authorization Form, click here
For a CMS Out-of-State Authorization Request Form, click here
For Behavioral Health Authorizations, please Fax to: (800) 294-8642