Authorizations
Authorization details
General Information
Preferred IPA
P.O. Box 4449
Chatsworth, CA 91313
Phone: (800) 874-2091
Fax: (800) 874-2093
Office Hours: Monday through Friday 8:30 A.M. – 5:00 P.M.
Authorization for Admission
Nurse Case Managers are available 24/7 to facilitate transfers to in network facilities and/or provide authorization for admission. Refer to attached contact list or call:
Monday – Friday 8:30 AM – 5:00 PM (800) 874-2091
Monday – Friday 5:00 PM – 8:30 AM + Weekend & Holidays (800) 280-8008
2024 Holiday Schedule (After hours Phone Open)
New Year’s Day - Monday, January 1, 2024
Martin Luther King Jr. Day - Monday, January 15, 2024
President's Day - Monday, February 19, 2024
Memorial Day - Monday, May 27, 2024
Independence Day - Thursday, July 4, 2024
Labor Day - Monday, September 2, 2024
Thanksgiving Day - Thursday, November 28, 2024
Day After Thanksgiving - Friday, November 29, 2024
Christmas Day - Wednesday, December 25, 2024
Health Plan Prescription Drug Prior Authorization Form
Alignment Prescription Drug Prior Auth Link
Blue Cross Prescription Drug and Step Therapy Prior Auth Forms
Blue Shield Promise Health Plan Medi-Cal Prescription Drug and Step Therapy Prior Auth Forms
Brand New Day Prescription Drug Prior Auth Forms
Health Net Prescription Drug and Step Therapy Prior Auth Forms
Humana Prescription Drug Prior Auth Forms
LA Care Covered CA Prescription Drug and Step Therapy Prior Auth Forms
LA Care Medi-Cal CA Prescription Drug and Step Therapy Prior Auth Forms
Molina J-Code Drug Prior Authorization
WellCare Injectable Infusion Forms
WellCare Hep C Treatment Forms