Get texanplus prior authorization form

For questions about pre-approval (prior authorization), call Member Services at 1-888-839-9909 (TTY 711).

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/.

Call us today at 1-888-4LA-CARE (1-888-452-2273) to apply for health care coverage. L.A. Care Health Plan representatives are available 24 hours a day, 7 days a week, including holidays to help you.

L.A. Care is the health plan for Medi-Cal members in Los Angeles County .

If you think more information or an additional form may be needed, please check the issuer's website before faxing or mailing your request. Please fax form to Superior HealthPlan at 1-866-399-0929.

Except for emergency services, post-stabilization services, and services provided to you during an approved inpatient admission, all services from an out-of-network provider must be prior authorized. Claims for services from out-of-network providers that are not approved before the service is given may be denied.

Timely Access to Care APPOINTMENT TYPEMUST GET APPOINTMENT WITHINUrgent care appointments that do not require pre-approval (prior authorization)48 hoursUrgent care appointments that do require pre-approval (prior authorization)96 hoursNon-urgent (routine) primary care appointments10 business days4 more rows

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.