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Get MS Magnolia Health MS-PAF-0618 2016-2024

OUTPATIENT MEDICAID Fax to: 1-877-650-6943 Prior Authorization Fax Form Standard Request - Determination within 3 calendar days and/or 2 business days of receiving all necessary information Expedited Request - I certify that following the standard authorization decision time frame could seriously jeopardize the member s life, health, or ability to attain, maintain, or regain maximum function. URGENT REQUESTS MUST BE SIGNED BY THE REQUESTING PHYSICIAN TO RECEIVE PRIORITY. X * INDICATES RE.

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