aetna better health prior authorization phone number

Your PCP can send you to a specialist. Prior Authorization for SUD Form. Request a letter of authorization (LOA) or guarantee of payment (GOP) prior to services rendered. Contact us by phone. The Provider Service Center helps with contracting, patient services, precertification and many other questions. HMO and Medicare Advantage - 1-800-624-0756. Indemnity and PPO-based plans - 1-888-MD AETNA ( 1-888-632-3862) Voluntary plans - 1-888-772-9682. Worker’s comp - 1-800-238-6288. 1-844-348-0621 . a health care crisis COVID-19 has presented a difficult situation for people in need of medical care. Aetna Better Health® of Florida 1340 Concord Terrace Sunrise, FL 33323 . Original review: Nov. 14, 2020. The Aetna Foundation is donating $500,000 to the Americares COVID-19 Mental Health and Psychosocial Support project to help frontline health care workers, particularly those who serve low-income populations, improve their mental health awareness, knowledge and resiliency, and understand the mental health concerns impacting their patients. These doctors are called specialists. Please note that most pharmacy prior authorization request forms need to be faxed to ESI at 1-877-251-5896 and prior authorization … Electronic Prior Authorization integrates directly with electronic health records (EHRs), enabling healthcare professionals to easily obtain prior authorizations in real time at the point of care. 2. For this, I am truly grateful. A simple way to pay your premiums online. Prior authorization—sometimes called precertification or prior approval—is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage. All Savers Supplement United Healthcare Provider Number; Pharmacy(Prior Authorization Phone Number) 800-711-4555: Prior Authorization and Notifications: 800-999-3404: Appeal By Phone: 800-291-2634 (ASIC Members) Each Medicaid beneficiary is assigned to one of the KanCare health plans. Requests can be made by telephone: 202-408-4823 or 1-800-408-7510. Dental. Aetna Provider Phone Number for below plans - 800-624-0756. To be used for completing the Electronic Remittance Advice (ERA) Authorization Agreement Improves time to therapy. If you have an Aetna Better Health member that needs one or more of these services, please contact Member Services at 1-866-212-2851 (ICP) or 1‑866‑600-2139 (Premier Plan) for more information. COVID-19 Vaccine information Some services such prior authorization is not a coverage or Prior authorization is a requirement that a health care provider obtain approval from Medicare to provide a given service. IL HFS Disclaimer: An authorization is not a guarantee of payment.Providers must enroll with Illinois Department of Health and Family Services and obtain a valid Medicaid ID number prior to the date of service to qualify for reimbursement for services. Some of these services require prior authorization. If you can't submit a request via telephone, please use our general request form or one of the state specific forms below and fax it to the number on the form. Please allow 10-15 business days for processing once enrollment is received. *Last Name. Notice: Beginning 7/23/19 the Innovation Health member portal has changed to the new Aetna Health portal. 5. Aetna Student Health Agency Inc. is a duly licensed broker for student accident and health insurance in the Commonwealth of Massachusetts. AETNA BETTER HEALTH® OF WEST VIRGINIA. Medicare and Aetna Medicare won’t be responsible either. Do not include a fax coversheet. If services are needed beyond the approved dates of service, then prior authorization of those services is required. SFLPEC-1302-19 July 2019 . Please provide the criteria reference number associated with the requested medication. 1-866-827-2710 . Electronic requests eliminate time-consuming paper forms, faxes and phone calls. Prior Authorization Forms - Aetna Better Health Aetnabetterhealth.com If covered services and those requiring prior authorization change, we will notify you at least 60 days in advance via the provider newsletter, e-mail, website, mail, telephone or office visit. All claims should be submitted on the most current claim forms. The UM department hours of operation are 8 a.m. – 5:30 p.m., Monday through Friday. Aetna Medical and Behavioral health. If you have questions about what is covered, consult your Provider Manual or call 1-855-456-9126. Referrals and Prior Authorization . HAP adds industry veterans to execute Medicare and Medicaid expansion plans in key markets. A prior authorization is not a guarantee of payment. • Call with denial and pends (will request additional information for any pended request) ... • Phone call follow up for pending cases Coventry (Including workers compensation and auto injury) 800-937-6824. To become a contracted Meridian provider, call Provider Services at 866-606-3700. . Aetna Better Health has recently provided the following informaiton:. Fill in the blank areas; engaged parties names, places of residence and numbers etc. Contact Meritain Health customer service. Beacon Health Options serves more than 40 million people across all 50 states. Any incomplete sections will result in a delay in processing. The updated program will begin on November 9, 2020. Our dual-eligible Special Needs Plan (D-SNP) is a type of Medicare Advantage plan, available to people who have both Medicare and Medicaid. As an Aetna Better Health provider, you need to prescribe medically necessary therapy or medications for a member. Some of these services require prior authorization. Your PCP can send you to a specialist. Student health insurance plans are underwritten by Aetna Life Insurance Company (Aetna). Molecular Pathology Request Form. Access to Aetna's team of clinicians. Beneficiaries in KanCare will receive all the same services provided under the previous Medicaid delivery system, plus additional services. Starting immediately, a preauthorization number will be Aetna Better Health of Michigan is adopting temporary changes in its prior authorization protocols for inpatient admissions. Aetna has selected National Imaging Associates, Inc. (NIA) to provide utilization management for physical medicine. Prior authorization practice resources. 509 Progress Drive, Suite 117 Linthicum, MD 21090 . The KanCare health plans are Aetna Better Health of Kansas, Sunflower Health Plan, and UnitedHealthcare Community Plan of Kansas. Electronic Claim Fax Cover Sheet. Your doctor can ask for a coverage review by calling 1-800-437-3803, or by submitting an electronic prior authorization (PDF). Fax . Aetna Better Health’s vision provider is Superior Vision. ... All claims for CoventryCares of West Virginia should be filed to Aetna Better Health of West Virginiabeginning September 26, 2016. Please click on the link to access Centene's Illinicare Provider portal for review of claims with a date of service prior to 12/01/2020. Plan: Phone number: Fax number: Fee -For Service (Magellan) 1 (800) 477 3071 1 (800) 365 8835 Anthem Medicaid 1 (855) 661 -2028 1 (844) 879 2961 Aetna Better Health 1 (855) 300-5528 1 (855) 799-2550 Forms And Applications For Health Care Professionals. NOTICE FOR AETNA BETTER HEALTH PLAN MEMBERS: Unfortunately, at this time, Aculabs is not a provider for Aetna Better Health plans. The hospice shall submit prior authorization requests to the Aetna Better Health of Nebraska prior to the onset of services. Aetna: For non-network providers, prior authorization requests can be made by fax or phone call. For assistance and information, contact Aetna Student Health Customer Service at 1-877-480-4161. Step 3 – The first emboldened fields at the top of the form will require the Plan/Medical group name, and the group phone and fax number. AETNA BETTER HEALTH® OF FLORIDA . Get the AETNA BETTER HEALTH OF LOUISIANA Prior Authorization Form Phone: 18552420802 Physical Health Fax you require. Thank you for submitting. Pharmacy Prior Authorization AETNA BETTER HEALTH PENNSYLVANIA & AETNA BETTER HEALTH KIDS DPP-4 Inhibitors (Medicaid) This fax machine is located in a secure location as required by HIPAA regulations. Fax: 1-855-633-7673. prior authorization as per Ambetter policy and procedures. 800-238-6279. The health plan will be hosting Provider Trainings (Orientations) to train and familiarize our providers on the systems. This authorization is to remain in effect until Aetna Better Health of West Virginia has received an ERA cancellation notification from me that affords Aetna Better Health of West Virginia a reasonable opportunity to act on it. processes and policies related to our transition to Aetna Better Health. There are two fax numbers: outpatient service requests call 855-320-8445, inpatient service requests and concurrent review call 855-687-6955. If the member does not have an ID card, Note: The General Information for Authorization form (13-835) must be typed and be page 1 of your fax to avoid delays. The test will not require prior authorization and will paid at 100% of Medicaid: HCPSC Code Description Reimbursement. Complete the General Information for Authorization form (13-835) with all supporting documentation and fax it to: 1-866-668-1214. You can also look on … It's easy to update a provider address, phone number, fax number, email address or initiate an out-of-state move or a change in provider group. Electronic requests eliminate time-consuming paper forms, faxes and phone calls. There are two fax numbers: outpatient service requests call 855-320-8445, inpatient service requests and concurrent review call 855-687-6955. Business proposal request I am interested in one of eviCore's solutions. Ambetter can help. IlliniCare Health is now Aetna Better Health of Illinois! contact Aetna Better Health Pennsylvania Medicaid at 1-866-638-1232 or Aetna Better Health Kids at 1-800-822-2447 with questions regarding the Prior Authorization process. The purpose of this policy is to describe Aetna Better Health’s process prior authorization decision-making for pediatric day healthcare services. HAP offers extended financial relief for members through Sept 30 in response to COVID-19 pandemic. If you have questions or concerns about your health insurance coverage, we'd love to hear from you. Please allow 10 -15 business days for processing once enrollment is received. We will review tons of valuable information including: Phone Number: Policy ID Number: Member is Currently Inpatient: Yes No ... Pharmacies are allowed to dispense a 72 hour emergency supply while authorization is pending. This questionnaire is designed to capture information about your agency that is necessary for Aetna Better Health of NY (ABHNY) to obtain confirmed visits and receive electronic claims from providers. prior authorization forms can be found by clicking on hyperlinks provided to the right. Aetna Better Health of West Virginia . To become a contracted Meridian provider, call Provider Services at 866-606-3700. About CoverMyMeds. For the most up to date information available on our transition, visit our transition webpage at : 1. Select an option belowRequest a call Email Aetna Attend a meeting Aetna's mailing address Request an information kit. Generally, you must get your health care coverage from your primary care physician (PCP). Aetna Better Health & Aetna • Better Health of Virginia. 500 Virginia Street East, Suite 400 Charleston, WV 25301 . For scheduled ambulatory surgery, call our Preauthorization Department at 1-800-279-1878, at least 72 hours prior to the surgery. AETNA BETTER HEALTH® OF MARYLAND . If you are uncertain that prior authorization is needed, please submit a request for an accurate response. Instructions on how/where to submit the completed form are included at the bottom of the form itself. COVID-19 UPDATES. processes and policies related to our transition to Aetna Better Health. The good thing is that Aetna is accepted most places. Our members’ health is important to us, now and always. Aetna Global Benefits (UK) Limited 50 Cannon Street London EC4N 6JJ. card, prior authorization forms may need an aetna better health plan with that provides information on, phone or prescription drug by the above. AETNA BETTER HEALTH® OF FLORIDA . Find a form.Applications and forms for healthcare professionals and their patients. *First Name. Texas. Revised 7/2018. Official Site of Anthem Blue Cross Blue Shield, a trusted health insurance plan provider. Phone: • Call the Aetna Better Health of KS PA request line 1-855-221-5656 ... • Check if a prior authorization is required Phone: ... • Toll Free Fax Number: 855-225-4102 • Local Toll Fax Number: 860-975-3251 • Secure Provider Portal 8 1 -855 -336 -6054 Behavioral Health/Psych Testing 1 -888 -604 -6106 1 -855 -301 -1564 Dental (Avesis) 1 -855 -214 -6776 Authorizations will include an authorization number, the provider type, the total number of units being approved, and the validity period. ... Aetna Better Health – Todos los derechos reservados. And if you’ve lost access to insurance, we want to help you get the coverage you need. Aetna Student Health Agency Inc. is a duly licensed broker for student accident and health insurance in the Commonwealth of Massachusetts. Starting immediately, a preauthorization number will be 800-451-7715. Private, for-profit plans often require Prior Authorization. STATEMENT OF OBJECTIVE: The objectives of the policy are to assure appropriate authorization of services for pediatric day healthcare including: Documentation requirements Certification period Services provided by Out-of-Network providers are not covered by the plan. April 25th, 2019 - Aetna & Aetna Better Health Notice Effective 05/01/2019, Aculabs will now be a provider of laboratory services for all commercial Aetna plans. Aetna Better Health of Nevada today announced it has donated $65,000 to R.E.A.C.H, a non-profit organization that works to improve community health services and access to care in Nevada. This system transition will not affect any member or plan information and can still be accessed through the member portal "Log In" button on innovationhealth.com. Healthcare is essential. Open it up using the online editor and begin adjusting. Request for ECT/TMS. Aetna’s Preferred Method for Prior Authorization Requests. Coventry (Including workers compensation and auto injury) 800-937-6824. Continuity of Care Consultation Sheet. Find a form.Applications and forms for healthcare professionals and their patients. Available for PC, iOS and Android. 8 1-855-336-6054 Behavioral Health/Psych Testing 1-888-604-6106 1-855-301-1564 Dental (Avesis) 1-855-214-6776 Aetna Better Health Pennsylvania / Aetna Better Health Kids at 1-877-309-8077. Fax signed forms to . Join Our Network. Your PCP will issue referrals to participating specialists and facilities for certain services. We can help you find out if you qualify. Fax and call for approvals & denials and authorization number (will leave a voicemail). Get the AETNA BETTER HEALTH OF LOUISIANA Prior Authorization Form Phone: 18552420802 Physical Health Fax you require. If you do not hear back from us within 5 business days, please call 800-792-8744, option4. Some health care will be given by other doctors. Some health care will be given by other doctors. Puerto Rico prior authorization. Payment is made in accordance with a determination of the member’s eligibility, benefit limitation/exclusions, evidence of medical necessity and other applicable standards during the claim review. Please note that the Aetna Student Health Precertification List is currently under revision. 151 Farmington Avenue, Hartford, CT 06156. Aetna allowed me to learn much more concerning pharmacy practice in a managed care setting. Prior Authorization of Benefits is not the practice of medicine or the substitute for the independent medical judgment of a treating physician. Complete this form in its entirety. Complete/review information, sign and date. Oregon. These doctors are called specialists. Fill out, securely sign, print or email your AETNA BETTER HEALTH Prior Authorization Form instantly with SignNow. Health Alliance Plan, a Michigan-based nonprofit health plan, has named Kristy O’Connor Strain as director of Medicare product and Medicare. If you are not the intended recipient any use, distribution, or … Massachusetts license number: 10041444. The test will not require prior authorization and will paid at 100% of Medicaid: HCPSC Code Description Reimbursement. Use our Prior Authorization Prescreen tool.. Standard prior authorization requests should be submitted for medical necessity review at least five (5) business days before the scheduled service delivery date or as soon as the need for service is identified. When conditions are met, we will authorize the coverage of Vivitrol (PA88). In order to ensure and maintain a high level of medical care, all providers are credentialed by Meridian. Change the template with exclusive fillable fields. American Health delivers outcomes and demonstrates value through its products and services. 2 855 454 5043 Retro Review 1 -888 -470 -0550, Opt. For Part D prior authorization forms, please see the Medicare section. If you wish to request a Medicare Part Determination (Prior Authorization or Exception request), please see your plan’s website for the appropriate form and instructions on how to submit your request. Number Aetna.com Get All ››. *Phone number. Round the clock support for you and your family. Buckeye Health Plan has Reduced Prior Authorization Requirements. Providers, you can check this section of the website for any changes to the Buckeye Prior Authorization policies/processes. As an Aetna Better Health of New York provider, you may need to prescribe a necessary therapy for a member. Effective January 1, 2021, several phone and fax numbers were updated in the transition with our new partner, Evolent Health. NOTICE FOR AETNA BETTER HEALTH PLAN MEMBERS: Unfortunately, at this time, Aculabs is not a provider for Aetna Better Health plans. Pharmacy. California license number: OB84599. All fields marked with an asterisk (*) are required. 888-632-3862. Clear Health Alliance is a Managed Care Plan with a Florida Medicaid contract. Helping healthcare organizations confidently provide informed, collaborative and effective care. 800-451-7715. Complex imaging, MRA, MRI, PET, and CT Scans need to be verified by NIA. April 25th, 2019 - Aetna & Aetna Better Health Notice Effective 05/01/2019, Aculabs will now be a provider of laboratory services for all commercial Aetna plans. This authorization is to remain in effect untilAetna Better Health of Ohio has received an ERA cancellation notification from me that affords Aetna Better Health of Ohio a reasonable opportunity to act on it. To compare Aetna vs. Cigna for yourself, consider the type of health insurance plan you require. Electronic Prior Authorization integrates directly with electronic health records (EHRs), enabling healthcare professionals to easily obtain prior authorizations in real time at the point of care. IlliniCare Health is now Aetna Better Health of Illinois! The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. Aetna Medicare Advantage D-SNPs. How to request prior authorization: 19 Prior Authorization Requests Or by phone: 888.693.3211 7:00 a.m. to 8:00 p.m. (CST) Monday - Friday eviCore fax number: 1-844-82AETNA Fax forms available at: www.evicore.com WEB www.evicore.com Available 24/7 and the quickest way to create prior authorizations and check existing case status *Zip code. The list of CPT codes requiring authorizations and the process will remain the same. A physician will need to fill in the form with the patient’s medical information and submit it to CVS/Caremark for assessment. Prior Authorization for Drug Screening Form. Beginning September 1, 2018, for Delaware, New York, Pennsylvania and West Virginia, providers must request prior authorization for physical therapy, occupational therapy and chiropractic services through NIA at RadMD.com. HMO and Medicare Advantage - 1-800-624-0756 (TTY: 711) Indemnity and PPO-based plans - 1-888-MD AETNA ( 1-888-632-3862) (TTY: 711) Voluntary plans - 1-888-772-9682 (TTY: 711) Worker's comp - 1-800-238-6288 (TTY: 711) ASA and Meritain - use phone number on member's ID card. For some services, your PCP is required to obtain prior authorization from Aetna Medicare. 800-238-6279. Step 2 – This example will be only for the State of California but can be applied generically to all other forms. Please review the information below regarding EVICORE authorizations and appeal guidelines.. Medical Prior Authorizations: Note: If a claim denies not authorized, providers must request an authorization before submitting a provider appeal. State by state and business by business, rules to keep people safe during the pandemic and help limit the spread of the virus have varied. Some health care will be given by other doctors. This questionnaire is designed to capture information about your agency that is necessary for Aetna Better Health of NY (ABHNY) to obtain confirmed visits and receive electronic claims from providers. Aetna Better Health® of Virginia ... 2020 Added Benefits For any services that do not list a specific phone number, call Member Services at 1‐855‐652‐8249 (TTY: 711) and ask to be transferred to a Care Manager. Pharmacy Prior Authorization AETNA BETTER HEALTH PENNSYLVANIA & AETNA BETTER HEALTH KIDS Acamprosate (Medicaid) This fax machine is located in a secure location as required by HIPAA regulations. Our mission and values guide the way we treat our providers, members and each other. Your Primary Care Provider (PCP) provides most of your health care. Please note that when a hospital first notifies the plan of an emergent admission, Prior Authorization criteria is available upon request. The health plan will be hosting a WebEx to familiarize our providers on the PA portal. MCG’s transparent assessment of the latest research and scholarly articles, along with our own data analysis, gives patients, providers and payers the vetted information they need to feel confident in every care decision, as well as providing a means to have collaborative discussions about care. We review requests for prior authorization (PA) based on medical necessity only. Highmark Health Options is a managed care organization serving vulnerable populations that have complex needs and qualify for Medicaid. Prior Authorization of Benefits is not the practice of medicine or the substitute for the independent medical judgment of a treating physician. In addition to PPO plans, offers you other Medicare Advantage plan options — many with a $0 monthly plan premium. ... All claims for CoventryCares of West Virginia should be filed to Aetna Better Health of West Virginiabeginning September 26, 2016. The health plan will be hosting Provider Trainings (Orientations) to train and familiarize our providers on the systems. We will review tons of valuable information including: Pharmacy. Shop plans for Medicare, Medical, Dental, Vision & Employers. Hours: 8 a.m. to 6 p.m. local time, Monday through Friday. Referrals Your Primary Care Provider (PCP) provides most of your health care. How to obtain prior authorization. As an Aetna Better Health provider, you need to prescribe medically necessary therapy or medications for a member. Some of these services require prior authorization. A current list of the services that require authorization is available via the secure web portal. 888-632-3862. Medical Prior Authorization Request Form. The card should have printed at the top, 'Aetna International' to be eligible for direct settlement. With a headquarters in Hartford, CT., and about 100 years of history, Aetna is now owned by CVS Health Organization. Some services require prior authorization from Sunflower Health Plan in order for reimbursement to be issued to the provider. AETNA BETTER HEALTH OF KENTUCKY DEPARTMENT PHONE FAX/OTHER Medical Prior Authorization 1 -888 725 4969 855 454 5579 Concurrent Review 1 -888 470 0550, Opt. You will be contacted by an eviCore representative within 5 business days. 24/7 assistance via toll-phone, fax or email. For patients with an Express Scripts ID card or TRICARE beneficiaries, ePrescribe to: Express Scripts Home Delivery NCPDP ID 2623735 4600 North Hanley Road St. Louis, MO 63134. This will help health care facilities reduce administrative burdens on the health care system during the national COVID-19 pandemic. Please note that when a hospital first notifies the plan of an emergent admission, All claims should be submitted on the most current claim forms. Referrals . If the retro authorization request is denied, a provider appeal can be … Student health insurance plans are underwritten by Aetna Life Insurance Company (Aetna). Open it up using the online editor and begin adjusting. Tell us more. Relieves administrative burdens. Aetna Better Health of Maryland (ABHM) (866) 827-2710 (877)-270-3298 or And we want to ensure you are prepared. Providers Authorizations Aetna Better Health of Virginia. CoverMyMeds is the fastest and easiest way to review, complete and track PA requests. Pre-trip guidance to help with your next move. If … AETNA California Prior Prescription Authorization Form. Aetna Vs. Cigna: Products to Compare. ... Telephone Number: 855.214.6777 . In response to your feedback, Buckeye has removed 25 services from our prior authorization list effective March 31, 2021. Please allow 10 -15 business days for processing once enrollment is received. April 5, 2021. You can call Meritain Health at (800) 748-0003 toll free number, write an email, fill out a contact form on their website www.meritain.com, or write a letter to Meritain Health, 300 Corporate Parkway, Buffalo, New York, 14226, United States. Aetna: For non-network providers, prior authorization requests can be made by fax or phone call. For Part D prior authorization forms, please see the Medicare section. Fill in the blank areas; engaged parties names, places of residence and numbers etc. Requests can be submitted through NaviNet. AETNA BETTER HEALTH OF KENTUCKY DEPARTMENT PHONE FAX/OTHER Medical Prior Authorization 1 -888 725 4969 855 454 5579 Concurrent Review 1 -888 470 0550, Opt. 7. Start a free trial now to save yourself time and money! Select from the drop down box the County # of Recipient Residence. Our electronic prior authorization (ePA) solution is HIPAA-compliant and available for all plans and all medications at no cost to providers and their staff. In addition, members may access their information 24 hours a day, seven days a week through the Aetna Better Health of California website and mobile app. Aetna Better Health of California provides members full medical benefits, including vision coverage, some mental health and substance use services, and pre-natal and postpartum care. Please provide the criteria reference number associated with the requested medication. Forms And Applications For Health Care Professionals. Complete this form to have us call you. For pharmacy drugs, prescribers can submit their requests to Humana Clinical Pharmacy Review (HCPR) — Puerto Rico through the following methods: Phone requests: 1-866-488-5991. Aetna Authorization Form. Fax signed forms to Aetna Better Health Pennsylvania / Aetna Better Health Kids at 1-877-309-8077. Instructions: 1. Aetna Better Health® of Florida 1340 Concord Terrace Sunrise, FL 33323 . Aetna Better health Provider Phone Number: Member Services/Eligibility Verification Prior Authorizations Provider Relations: 866-638-1232 ← Improves time to therapy. Please join the Aetna Better Health of Illinois Provider Experience Team for training on prior authorization submissions. Please Select Date for Registration. Select your state to contact an Ambetter representative in your service area. The medical provider network includes more than 700,000 doctors and 5,700 hospitals. Referrals and Prior Authorization . Plan Specific Educational Docs” section of RadMD.com under Aetna. You'll get an alert if the medication needs a coverage review—that's what Express Scripts calls prior authorization. Effective October 1, 2015, new members were added to this plan; however, some members may not have received ID cards prior to their effective date. Dental. COVENTRYCARES/AETNA BETER HEALTH KENTUCKY DEPARTMENT PHONE FAX Medical 1 -888 -725 -4969 1 -855 -454 -5579 Behavioral Health/Psych Testing 1 -888 -604 -6106 1 -844 -885 -0699 Dental (Avesis) 1 -800 -327 -4462 Express Scripts 1 -877 -215 -4100 1 -877 -554 -9137 Pain Management (Triad) 1 -888 -584 -8742 1 -888 -229 -5680 The CVS/Caremark prior authorization form is to be used by a medical office when requesting coverage for a CVS/Caremark plan member’s prescription. They are at the heart of all we do. California license number: OB84599. ... Telephone Number: 855.214.6777 .