- Providence Prior Authorization Form
- Fax to: 1 (503) 574-8646 / 1 (800) 249-7714
- Phone: 1 (503) 574-7400 / 1 (877) 216-3644
- Providence Prior Authorization Form (Services Only)
- Services Requests Fax to: 1 (574)-6464 / 1 (800) 989-7479
- Services Requests Phone: 1 (574)-6400 / 1 (800) 638-0449
Providence Prior (Rx) Authorization Form
A Providence prior authorization form allows a physician to request coverage for a medication that their patient's Providence Health Plan insurance does not cover. Within this form, they must justify their reasons for making this request and detail trials and tests that led to their diagnosis and resultant request.
Updated November 15, 2024
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