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Prior Authorization Request Form Fax: (415) 357-1292 Telephone: (415) 547-7818 ext.7080 NOTE: All fields marked with an asterisk (*) are required. Select line of business: Medi-Cal Healthy Kids Healthy.

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Call us today at 1-888-4LA-CARE (1-888-452-2273) to apply for health care coverage. L.A. Care Health Plan representatives are available 24 hours a day, 7 days a week, including holidays to help you.

Timely Access to Care APPOINTMENT TYPEMUST GET APPOINTMENT WITHINUrgent care appointments that do not require pre-approval (prior authorization)48 hoursUrgent care appointments that do require pre-approval (prior authorization)96 hoursNon-urgent (routine) primary care appointments10 business days4 more rows

A pre-authorization is a restriction placed on certain medications, tests, or health services by your insurance company that requires your doctor to first check and be granted permission before your plan will cover the item.

If you would like help finding the phone number of your primary care provider, please call SFHP Customer Service at 1(415) 547-7800 weekdays from 8:30am – 5:30pm.

The GHPP is a prior authorization program. This means that a Service Authorization Request (SAR) must be submitted to the GHPP State office for approval for all diagnostic and treatments services, except for emergencies.

Pharmacy providers and prescribers can submit a PA request via fax by utilizing the following approved forms: 50-1, 50-2, 61-211, or the Medi-Cal Rx PA Request Form, available January 1, 2022, in Reference Materials at .medi-calrx.dhcs.ca.gov/provider/forms/.

L.A. Care is the health plan for Medi-Cal members in Los Angeles County .

For questions about pre-approval (prior authorization), call Member Services at 1-888-839-9909 (TTY 711).

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232