What is a Prior Authorization?

Certain medications have a status of Prior Authorization Required (PAR).  If your doctor wants to prescribe a PAR drug, he or she will submit a request for approval before the drug can be dispensed as a covered benefit.  If your pharmacist receives notification that a drug you were prescribed requires prior authorization, ask your pharmacist to contact us.

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Services Requiring Prior Authorization

Download our PDF for a complete list of services requiring prior authorization.

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Prior Authorization Form

https://www.powerdms.com/public/PHPNI/documents/1242218

Authorization for Use and Disclosure of Protected Health Information

Specify who can receive your health information and exactly what information that they can receive with this simple form.

https://www.powerdms.com/public/PHPNI/documents/1451695

Authorization for Use and Disclosure of Protected Health Information

Specify who can receive your health information and exactly what information that they can receive with this simple form.

https://www.powerdms.com/public/PHPNI/documents/1451695

Utilization

PHP requires prior authorization for certain services that are provided to our members, including off-plan referrals. Please familiarize yourself with these services and requirements.

/providers/resources-for-providers/utilization

Pharmacy Prior Authorization Request Form

https://www.powerdms.com/public/PHPNI/documents/1461222

Medical Management Forms

Here's a quick link to the Prior Authorization Request form as well as out-of-network referral paperwork and more.

https://provider.phpni.com/forms

Medical Management

For questions about referrals and prior authorization requests, utilization reviews, disease management programs, and other health services, contact:

PHP Medical Management
260-432-6690, ext. 12

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