Prior Authorization Tips - How to Fill Out the PA Form

Date: 03/02/18

How to complete the PA form:

In order to efficiently process authorization requests, Magnolia requests that providers complete each field of the authorization forms, especially the fields with an asterisk. Incomplete forms are subject to being faxed back to the provider.

If you are the servicing provider and are submitting the authorization request, list yourself as the requesting and servicing provider. By doing this, it eliminates unnecessary outreach to the referring physician, allows for one contact person, and ensures that you are aware of any requests for additional information.   

Providers should include a valid contact number on the PA form, for both Requesting and Serving Provider’s contact phone number. We have noticed that some providers will put the main hospital number on the PA form, in which that number only directs us to patient information not the appropriate contact to request additional information or provider a notification of determination. We want to effectively be able to communicate with the requestor in a timely manner.