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Description of service start date of service end date of service service code if available (hcpcs/cpt) new prior authorization check status complete. Fax the completed form to 888.610.1180. Web prior authorizations (eoc) id: Web medication prior authorization request form.
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Web description of service start date of service end date of service service code if available (hcpcs/cpt) for direct member reimbursement: You can find this by calling the prior authorization line at 888.608.8851 or.