Network providers requesting prior authorization for an elective admission or submitting an inpatient admission notification are required to submit online. Non-network providers are encouraged to submit online as electronic requests save time and improve accuracy.
Use this form for the following types of admissions: physical health, mental health, acute rehab facility/unit, long term acute care, skilled nursing facility (SNF), substance use disorder, partial hospitalization program (PHP) and intensive outpatient program (IOP).
- Created: Aug 18, 2020
- Modified: Aug 18, 2020
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