KS Prior Authorization Forms | Providers – Amerigroup

A Universal Clinical Prior Authorization Form and Universal Nonpreferred Drug Prior Authorization Form are now available for providers to submit prior authorization (PA) requests. These forms may be used for any drugs requiring PA and will be accepted by all KanCare MCOs for any KanCare member. Please submit completed forms and any required supplemental documentation to us via the contact information listed on the forms.

The Universal Clinical Prior Authorization Form and Universal Nonpreferred Drug Prior Authorization Form may be found on the Kansas Department of Health and Environment (KDHE) website and are also listed below. Please note: You may submit PA requests using these new KanCare forms or you may continue to use the KDHE drug-specific PA forms below. Our PA department will accept PA requests on either form.





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