Get Gold Coast Authorization Form

​Prior Authorization Overview Medi-Cal beneficiaries (patients) receive health care services from medical, pharmacy, or dental providers enrolled in the Medi-Cal Program. Providers must receive authorization from Medi-Cal in order to provide and/or be paid for some of these services.

The GHPP is a prior authorization program. This means that a Service Authorization Request (SAR) must be submitted to the GHPP State office for approval for all diagnostic and treatments services, except for emergencies.

Agency Details Website: Centers for Medicare and Medicaid Services (CMS) Contact: Contact the Centers for Medicare and Medicaid Services (CMS) Local Offices: Contact State Medicaid Offices. Toll Free: 1-800-633-4227. ... TTY: 1-877-486-2048. Forms: Centers for Medicare and Medicaid Services Forms.

Pharmacy providers and prescribers can submit a PA request via fax by utilizing the following approved forms: 50-1, 50-2, 61-211, or the Medi-Cal Rx PA Request Form, available January 1, 2022, in Reference Materials at .medi-calrx.dhcs.ca.gov/provider/forms/.

“Prior Authorization” (PA) refers to a request for coverage of Medi-Cal Rx pharmacy benefit or services, which includes documentation establishing that the requested pharmacy benefit or service is medically necessary or a medical necessity for the Medi-Cal beneficiary based upon an individualized assessment by their ...

You can visit your local county human services office. You can use your information to confirm your Medi-Cal eligibility and get a temporary identification card. This will allow you to get services until your enrollment is complete.

To file a claim, you must submit a Medi-Cal Claim Form for Beneficiary Reimbursement. The claim form must be filled out in blue or black ink; • The claim form must have an original signature (no copies will be accepted); The Claim Form must include: • A photo copy of your Medi-Cal Beneficiary Identification Card (BIC).

The GHPP is a prior authorization program. This means that a Service Authorization Request (SAR) must be submitted to the GHPP State office for approval for all diagnostic and treatments services, except for emergencies.