Kentucky Medicaid Mco Prior Authorization Request Form Page 2

Download a blank fillable Kentucky Medicaid Mco Prior Authorization Request Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Kentucky Medicaid Mco Prior Authorization Request Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

MAP 9 –MCO 012016
Kentucky Medicaid MCO
Prior Authorization Phone Numbers
ANTHEM BLUE CROSS BLUE SHIELD KENTUCKY
DEPARTMENT
PHONE
FAX
Precertification/Notification
1-855-661-2028
1-800-964-3627
Pharmacy
1-855-661-2028
Dental (DentaQuest)
1-800-508-6787
Vision (EyeQuest)
1-888-696-9551
COVENTRYCARES/AETNA BETER HEALTH KENTUCKY
DEPARTMENT
PHONE
FAX
Medical
1-888-725-4969
1-855-454-5579
Behavioral Health/Psych Testing
1-888-604-6106
1-844-885-0699
Dental (Avesis)
1-800-327-4462
Express Scripts
1-877-215-4100
1-877-554-9137
Pain Management (Triad)
1-888-584-8742
1-888-229-5680
Radiology (NIA)
1-877-907-2363
1-800-784-6864
Vision (Avesis)
1-800-327-4462
HUMANA CARESOURCE
DEPARTMENT
PHONE
FAX
CareSource Medical Management
1-855-852-7005
1-888-246-7043
Behavioral Health (Beacon)
1-877-380-9729
1-781-994-7633
Dental (MCNA)
1-877-375-6262
1-954-628-3331
Pharmacy
1-800-364-6331
1-866-930-0019
Radiology (Health Help)
1-877-637-6940
1-877-667-0944
PASSPORT HEALTH PLAN
DEPARTMENT
PHONE
FAX
Email
General Number
1-800-578-0636
1-502-585-7989
Concurrent Review
1-502-585-2077
1-502-213-8997
Retrospective Review
1-502-585-7972
1-502-585-8207
Home Health
1-502-585-7320
1-502-585-8204
DME
1-502-585-7310
1-502-585-7990
Therapies
1-502-585-6055
1-502-585-8205
Cosmetics
1-502-585-7069
1-502-213-8998
Pain Management
1-502-212-6614
1-502-212- 6611
Appeals
1-502-585-7307
1-502-585-8461
High Dollar Radiology
1-888-693-3211 OR
1-888-693-3210
On line request:
(MedSolutions/eviCore)
1-877-791-4099
WELLCARE OF KENTUCKY
DEPARTMENT
PHONE
FAX
All Medical
1-800-351-8777
Inpatient
1-877-338-2996
Outpatient
1-877-431-0950
DME
1-877-338-3713
Home Health
1-866-886-4321
Prenatal Notifications
1-877-338-3659
Speech Therapy
1-855-620-1871
Outpatient – 1-877-544-2007
Behavior Health
1-855-620-1861
Inpatient – 1-877-338-3686
Dental (Avesis)
1-855-469-3368
1-866-653-5544
Vision (Avesis)
1-855-776-9466
1-855-591-3566
Main Fax: 1-866-896-2152
EviCore
1-888-333-8641
PT/OT 1-855-774-1319

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go
Page of 2