Prior Authorization
Authorizations
To prior authorize services or treatments for your patients, please complete and return the appropriate form below. If you have any questions, please call our Medical Management team at 1-855-458-4928.
Prior Authorization Requirements
Prior Authorization Requirements
Click on the button below to view the Prior Authorization List.
DownloadPrior Authorization Forms
Radiology Program & Genetic and Genomic Testing Program
Effective 2/1/2017 , please fax requests for a retrospective authorization to HealthyCT at 855-817-5696 using the General Authorization Request Form for Medical Services. Appeals should be faxed to HealthyCT at 855-817-5697