Submit a Preauth Request

Please prepare for the following steps:

1) Claim Profile
2) Treating Provider Information
3) Requesting Provider Information
4) Facility Information (Place of Service)
5) Service Requested & Type of Review
6) Submission & Attachments

NOTE: The requesting medical provider must submit the appropriate requested treatment and clinical notes. Type N/A for any information not applicable or available at time of request.

…………………………………………………