Forms & publications

To be completed by the vendor and the prescribing provider.

For metabolic disorders: oral enteral nutrition – children. Use this worksheet for EPA to request a metabolic formula for clients 20 years of age and younger.

Use EPA when the client has an immediate need for an urgent supply of oral enteral nutrition product. The EPA can be used for a one-time, one-month supply to address a severe nutrition disorder. The prescribing provider must clearly identify the urgent condition and provide justification for why an immediate supply of the product is medically necessary.

Use this form to request prior authorization for clients 20 years of age or less. A typed and completed General Authorization for Information form must be attached to your request order to be processed by the Health Care Authority.

To be completed by the vendor and the prescribing provider. A typed and completed General Authorization for Information form must be the coversheet for your request in order to be processed by the Health Care Authority.

Use this document cover sheet for submitting supporting claims documents, if necessary.

Step-by-step resource for entering dental authorizations through the provider portal in ProviderOne.

Step-by-step resource for entering DME authorizations through the provider portal in ProviderOne.

Step-by-step resource for entering medical authorizations through the provider portal in ProviderOne.

Presentation slides from January 2022 on Prior authorization for sign language requests.