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Get Kentucky Health Cooperative Prior Authorization Form

KENTUCKY HEALTH COOPERATIVE PRIOR AUTHORIZATION REQUEST FORM Please return completed form to KYHC UM Dept. Fax 502-379-4146. TREATING EMERGENT OR LIFE-THREATENING CONDITIONS DOES NOT REQUIRE PRIOR AUTHORIZATION Clinical information IS REQUIRED in the determination and lack of information will delay PA process KYHC requires Notification of Request 5 business days prior to service date when not urgent Per Policy PA requests may take up to 15 busin.

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