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Get AltaMed Authorization Request Form

Ry Care Physician (If different than referring Provider):___________________________________ ** For Inquiries or questions on authorization status or in general call the AltaMed Customer Service Department at: (866) 880-7805. All items listed within the Authorization Request form are required for submission to the Medical Management Department. Authorization Request forms will not be accepted if illegible and/or incomplete** .

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The tips below will help you fill out AltaMed Authorization Request Form easily and quickly:

  1. Open the form in our full-fledged online editor by hitting Get form.
  2. Complete the requested boxes which are colored in yellow.
  3. Press the arrow with the inscription Next to move from box to box.
  4. Go to the e-autograph solution to put an electronic signature on the template.
  5. Insert the relevant date.
  6. Check the whole document to make sure you have not skipped anything important.
  7. Press Done and download the new document.

Our solution allows you to take the entire process of executing legal forms online. For that reason, you save hours (if not days or weeks) and get rid of unnecessary payments. From now on, complete AltaMed Authorization Request Form from home, place of work, and even while on the move.

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