Service and device auth request forms

General authorization form

Medical prior authorization form - Updated 10/2015

For Medicare members: Use this form to request a pre-service organization determination when a Priority Health Medicare Advantage member is seeking services that may not be covered.

Service- or device-specific forms

Behavioral health forms

Authorization forms

Other behavioral health forms

Home health care services forms

Obesity services forms

Physician-supervised weight loss program forms:

Obstructive sleep apnea device and study forms

Rehab facility forms

Transplant services forms