Ambetter Outpatient Prior Authorization Fax Form 2025

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Health Net Prior Authorization Department Lines of BusinessContact NumbersProvider Portal Websites Medi-Cal (including CalViva Health and Community Health Plan of Imperial Valley) Fax: 800-743-1655 Phone: 800-421-8578 Transplant fax: 833-769-1141 provider.healthnetcalifornia.com3 more rows Aug 7, 2024
Fax completed forms to: for Medical (952) 853-8713, for Behavioral Health (952) 853-8830.
If you have any questions, please call HealthLink at 1-877-284-0102.
On July 6, 2022, Ambetter will be moving to a new fax number for pharmacy prior authorization requests: 1-800-977-4170.
Sometimes, we need to approve medical services before you receive them. This process is known as prior authorization. Prior authorization means that we have pre-approved a medical service. To see if a service requires authorization, check with your Primary Care Provider (PCP), the ordering provider or Member Services.
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To initiate the review process, complete this form, attach any additional relevant clinical information, and fax it using a secure cover sheet to (888) 265-0013. HealthHelp representatives and clinicians are available Monday-Friday, 8 AM to 8 PM EST.
Type or print; complete all sections. Attach sufficient clinical information to support medical necessity for services, or your request may be delayed. Fax the completed form to the Health Net Medi-Cal Prior Authorization Department at 1-800-743-1655.

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