chpw prior authorization form
Pharmacy prior authorization | Washington State Health Care
Download and complete the Pharmacy Information Authorization form (13-835A) and send to 1-833-991-0704. Request a change in fee-for-service (FFS) reimbursement.
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Wash. Admin. Code 182-543-7100 - Prior authorization
(2) All prior authorization requests must be accompanied by a completed General Information for Authorization form (HCA 13-835), in addition to any program
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Information for All Providers - Inquiry
Oct 8, 2024 Faxed requests may take up to 24 hours to process. For questions concerning: Contact: Prior authorization Forms,. Worksheet and References.
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