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Please note: Prior authorization requirements vary by plan. Please contact HPI Provider Services or visit Access Patient Benefits to review your patient's plan description for a full list of services requiring prior authorization.
Prior authorization forms below are only for plans using AchieveHealth® CMS. Please verify the correct prior authorization vendor prior to submitting forms; unverified prior authorizations will be returned.
Need to fax your form? Download forms below:
If your patient's plan requires Prior Authorization for a service or procedure listed below, please complete the Standard Prior Authorization Request form in addition to the applicable form below.
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