The purpose of prior authorization is to evaluate the appropriateness of a medical service based on criteria, medical necessity, and benefit coverage. Please review the current Prior Authorization List of medical services that require prior authorization. For certain services, providers are encouraged to submit prior authorization forms that outline information important in helping Medica determine appropriateness of care for Medica members seeking related services. Use the forms, listed below, as needed.

Note: Again, the full Prior Authorization List outlines all medical services requiring prior authorization from Medica. The following forms are to be used as the preferred method for requesting prior authorization for these particular services.