Corrected Prior Authorization Request Forms

Date: 09/25/18

California Health and Wellness Plan’s (CHWP’s) Outpatient Medicaid Prior Authorization Fax Form and Inpatient Medicaid Prior Authorization Fax Form have been corrected to indicate the standard requests determination time frame is within five business days and not 14 calendar days as previously indicated.

 

CORRECT

 

INCORRECT

Corrected forms are attached for reference and are also available online through www.cahealthwellness.com. To access the forms, select:

1.      www.cahealthwellness.com.

2.      For Providers.

3.      Provider Resources.

4.      Prior Authorization.

5.      Prior Authorization drop-down menu.

6.      Outpatient Medicaid Prior Authorization Fax Form or Inpatient Medicaid Prior Authorization Fax Form as applicable.

ADDITIONAL INFORMATION

If you have questions regarding the prior authorization request forms, contact the CHWP Medical Management Department at 1-866-724-5057.

For all other questions, contact your Provider Relations representative or call 1-877-658-0305.