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CA Imperial Health Holdings Precertification/Referral Request Form 2019
Get CA Imperial Health Holdings Precertification/Referral Request Form 2019-2024
RECERTIFICATION/REFERRAL REQUEST FORM Fax request to (626) 2835021 or Toll-free Fax (888) 9104412 or to check referral status call (626) 8385100 Date SubmittedSTANDARDURGENTReferring ProviderPhone.
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DME FAQ
P.O. Box 60160, Pasadena CA 91116 Electronic requests must use Office Ally with Payer ID's: IHHMG (IPA), IHP01 (CA Health Plan), IICTX (Texas).
(Provider ID: 1316498447).
Should you have specific questions regarding the program, please contact us at 1-800-838-8271 TTY users should call 711 for additional information.
(Provider ID: 1316498447).
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