To submit a prior authorization online, please click the button below to use the web form.
PDF forms are available below to submit a prior authorization through fax.
| Title | Categories | Update Date | Download |
|---|---|---|---|
|
Appeal Request Form 1 file(s) 16 downloads |
sscripts | December 4, 2020 | Download |
|
FDA Medwatch Form 1 file(s) 93 downloads |
BCBSAL, BCBSFL, HiLab, sscripts | December 15, 2020 | Download |
|
Louisiana Uniform PA Form 1 file(s) 10 downloads |
sscripts | December 4, 2020 | Download |
|
Prior Authorization Form 1 file(s) 600 downloads |
sscripts | December 4, 2020 | Download |