Affected by the wildfires? See our service advisory for members.

Prior Authorization Request Forms

Prior Authorization Request Forms are available for download below. Please select the appropriate Prior Authorization Request Form for your affiliation.

If your Member/Patient is in the L.A. Care Direct Network…

Use the L.A. Care Direct Network Prior Authorization Fax Request Form

Or enter your authorization using the online iExchange portal.

Questions? Review the Direct Network iExchange Training FAQ

If your Member/Patient is with any other Participating Physician Group (PPG)…