Follow the steps to successfully complete your authorization request.

1. Press the ‘Get Form’ button to obtain the Metroplus Prior Authorization Form and open it in your browser.
2. Indicate the type of request by selecting one of the options available, such as ‘Urgent Request’ or ‘New Request.’ Ensure to check the appropriate box.
3. In the section titled ‘Authorization/Tracking # on File,’ leave the field blank if this is a new request.
4. For E-Power generated cases, fill in the E-Power Cert # if applicable.
5. Select the relevant service level by marking one of the options under ‘Inpatient’ or ‘Outpatient’ services, depending on the type of medical care being requested.
6. Fill in all required fields, such as Name (Fax Sent From), Date of Request, Contact Number, Date of Service, Member Name, Provider Name, Member ID #, Provider Address, Member Date of Birth, Tax ID & NPI, ICD 10 Codes, CPT/HCPCS Codes, and MR#.
7. Add any comments relevant to the request in section B, noting that clinical information must be attached with the request.
8. Once all sections are completed, review the form for accuracy, then you can save your changes, download the document, print it for your records, or share it as needed.

Complete your Metroplus Prior Authorization Form online today for a seamless approval process.