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Prior authorization
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#	Item
41	Quick Reference Drug List US Script Contact Information: Prior Authorization Phone: Prior Authorization Fax: Clinical Hours: Monday – Friday 9:00 a.m. – 7:00 p.m. CountyCare Provider Inquiry Add to Reading List Source URL: www.countycarehealth.com Language: English - Date: 2015-03-09 16:47:38
42	Page 1 of 2 PRESCRIPTION DRUG PRIOR AUTHORIZATION REQUEST FORM Plan/Medical Group Name: _Community Health Group___________ Plan/Medical Group Phone#: ( Add to Reading List Source URL: chgsd.com Language: English - Date: 2016-01-14 20:15:56
43	Prior Authorization Request Form Fax this form and any supporting clinical information (office notes, Laboratory and Radiology Reports, Brief Medical History, or Treatment Plan) to: Total Care, A Today’s Options® of N Add to Reading List Source URL: www.totalcareny.com Language: English - Date: 2015-09-15 13:27:45
44	PRIOR AUTHORIZATION REQUEST FORM EOC ID: CFI Non Formulary Exceptionr r Add to Reading List Source URL: ironworkerbenny.com Language: English - Date: 2016-02-03 17:56:44
45	Prior Authorization Requirements Effective: CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both progr Add to Reading List Source URL: chgsd.com Language: English - Date: 2016-01-14 20:15:54
46	SAN DIEGO STATE UNIVERSITY BIOLOGICAL USE AUTHORIZATION APPLICATION Instruction for completing the Biological Use Authorization Application shall be read prior to completing this application and applicable attachments. Add to Reading List Source URL: bfa.sdsu.edu Language: English - Date: 2015-11-05 12:58:29
47	MEDICATION PRIOR AUTHORIZATION REQUEST MEDICATION PRIOR AUTHORIZATION Add to Reading List Source URL: www.countycarehealth.com Language: English - Date: 2015-02-25 12:00:06
48	IMPORTANT REMINDER ! ! ! Please be aware that you are required to receive prior authorization before receiving certain services, which are listed below:  The Medical Management program works closely with you and your Add to Reading List Source URL: www.teamsterslocal282.com Language: English - Date: 2014-03-21 11:18:15
49	Patient Authorization/Consent Form Individual states may have additional informed consent requirements for this type of testing - please review your own state law requirements prior to use Patient Information Last Name Add to Reading List Source URL: www.foundationone.com Language: English - Date: 2015-09-28 14:38:50
50	Prior Authorization Requirements Effective: This is not a complete list of drugs covered by our plan. For a complete and current listing, please call Member Services 24 hours a day, seven days a week at 1-888- Add to Reading List Source URL: chgsd.com Language: English - Date: 2016-01-14 20:15:54

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