Please Note: Authorization request must - Home - myNEXUS 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the 'Date of Request' at the top of the form. Specify whether this is a Standard, Retro, or Urgent Request.
  3. Fill in the 'Member Name', 'DOB', and 'Member ID#' in the required fields. Ensure accuracy as these details are crucial for processing.
  4. Complete the 'Requestor Name' and 'Requestor Email' sections. This information helps in communication regarding your request.
  5. Indicate if there is an authorization number and provide details about the caregiver's ability to assist.
  6. In the Agency Request section, fill out the certification period dates and specify the discipline along with visit requests.
  7. Ensure you check off all items on the REQUIRED CHECKLIST before submitting your form for review.

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A good example is house ownership. The owner has full access rights to the property (the resource) but can grant other people the right to access it. You say that the owner authorizes people to access it. This simple example allows us to introduce a few concepts in the authorization context.
Most insurance companies have specific forms that must be filled out and filed as part of the Prior Authorization procedure. Find those papers and complete them. You may get these forms on the insurance providers website or by contacting them directly.
Authorization involves the following phases: defining a security policy (set of rules), selecting an access control model to encapsulate the defined policy, implementing the model and enforcing the access rules. Each phase requires specific tools to be deployed.

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How to Complete an Authorization Form A description of the information to be used or disclosed. The identification of the person authorized to make the requested use or disclosure. The name of the person to whom the entity may make the requested use or disclosure.
For information about prior authorization, prescription exceptions, and utilization management, call 833-293-0659 or fax 844-521-6940. For information about home delivery, call 833-396-0309 or fax 833-389-4172.
A valid authorization must be written in plain language and contain the following elements: A description of the information to be used or disclosed. The identification of the person authorized to make the requested use or disclosure. The name of the person to whom the entity may make the requested use or disclosure.

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