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  • Dhsoha Prior Authorization Request Form

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Print Form Reset Form DHS/OHA Prior Authorization Request Form For internal use only: PA number: I Requesting provider name: Provider number: Contact name: Contact phone number: Contact fax number:.

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CIIS Related content

How to submit prior authorization requests to OHA...
For providers not enrolled with OHP, complete and submit the OHP 3113 form to OHP Provider...
Learn more
Oregon Health Authority : Pharmaceutical Services...
... revisions not available on the SOS website, please email HSD.Rules@dhsoha.state.or.us...
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A prior authorization (PA), sometimes referred to as a “pre-authorization,” is a requirement from your health insurance company that your doctor obtain approval from your plan before it will cover the costs of a specific medicine, medical device or procedure.

The provider may call the provider inquiry unit to request information on the authorization or to check the status of a request. In either scenario, the number to call is 1-800-537-8862.

Phone: 888-424-2070 (Toll Free) Email: paservices@dhs.state.ia.us.

As the Medical Home, PCPs should coordinate all healthcare services for PA Health & Wellness participants. Paper referrals are not required to direct a participant to a specialist within our participating network of providers. All out of network services (excluding ER and family planning) require prior authorization.

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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
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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