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Maryland authorization obtain health 2026

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  1. Click ‘Get Form’ to open the Maryland Authorization to Obtain Health in the editor.
  2. Begin by entering your full name in the 'CLIENT NAME' section, including last, first, middle initial, and any maiden or other names.
  3. Fill in your date of birth and social security number in the designated fields. Ensure accuracy for proper identification.
  4. Provide your current address, including city, state, and zip code. This information is crucial for correspondence.
  5. Enter your daytime and evening phone numbers for contact purposes.
  6. Select one of the options to either allow Planned Parenthood of Maryland to release information or request information from an outside healthcare provider. Fill in the respective names and addresses as required.
  7. Specify the health information you wish to be released by checking the appropriate boxes. You can also add any additional details if necessary.
  8. Review the conditions of authorization carefully before signing. Make sure you understand your rights regarding revocation and expiration of this authorization.
  9. Sign and date the form at the bottom. If applicable, a parent or legal guardian should also sign.

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Your doctors office is responsible for obtaining prior authorization. They will submit a request to your insurance provider to get approval, whether its for a service or for a medication. Usually, your physician will have a good idea of whether they need to get prior authorization.
Prior authorization is a way for insurance companies to review the medical service, procedure, item, or medication requested and make sure that its necessary for your care. Examples of services or procedures for which prior authorization may be needed include: admission to a hospital or skilled nursing facility.
Income Limits Monthly Income Limit Effective January 1, 2025 Household Size Adults Children 1 $1,801 $4,202​ 2 $2,433 $5,677 3 $3,065 $7,1525 more rows
Preauthorization is required for some professional services, medical procedures and HCPCS Level II codes. Maryland Medicaid Fee-for-Service will preauthorize services when the provider submits adequate documentation demonstrating that the service is medically necessary.
Review your plan documents or call the number on your health plan ID card for more information about the treatments, services, and supplies that require prior authorization under your specific plan.

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States may require PA for any drug covered by Medicaid but often do so for high-cost specialty drugs or non-preferred drugs.
You may apply online at or apply by telephone by calling the Maryland Health Benefits Exchange Consolidated Service Center. The toll free number is (855) 642-8572 or TTY (855) 642-8573. You may also apply at your local health department or local department of social services.

Related links

Prior authorization: What is it, when might you need it,

Aug 5, 2024 This is a process where your medical provider must get approval from your health plan before you can have a certain medical service or treatmentRead more

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