Prior Authorization (approval in advance) is required for many procedures, services or supplies, including transportation. Click here for information on obtaining an Emergency PA for medications. Below are the forms used for Prior Authorization.
Form 342 Prior Review and Authorization Request Note: a completed form is required.
Form 384 Attachment to Form 342 for Wheelchair Evaluation Request ***Please verify that all text typed into the form is present, once the form is printed. If not, please continue text on page 7, in "Comments" section.
Form 386 Wheelchair Modification/Repair Form ***This form is mandatory for prior authorizations.
ABA Therapy ABA Therapy Behavior Assessment Form - Form must be completed and submitted as supporting documentation for an ABA therapy PA request.
Form 384 Wheelchair Seating Evaluation Form - Attachment to Form 342 for Wheelchair Evaluation Request ***Please verify that all text typed into the form is present, once the form is printed. If not, please continue text on page 7, in "Comments" section.