BEHAVIORAL HEALTH SERVICES Pre-Authorization OP/IP Fax: 713.576.0939 Providers must submit the Prior Authorization Request Form. The form must include the following information:

Notification is required for any date of service change. Expedited Requests: If the standard time for making a determination could seriously jeopardize the life and/or health of the member or …

If a patient does not meet the medical necessity requirements for ambulance transportation, consider alternative options such as a wheelchair van, taxi, rideshare services like Uber, or …

Prior Authorization Fax Form Fax to: 855-537-3447 Request for additional units. Existing Authorization Units Standard and Urgent Pre-Service Requests - Determination within 3 …