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Manuals, Forms and Resources

New Biopharmacy/Buy and Bill PA Form

PA Health and Wellness (PHW) has recently implemented new Outpatient Biopharmacy/Buy and Bill forms that providers can use for J-code or medical benefit pharmacy requests. This new form will ensure that PHW clinical reviewers have all the necessary information to complete your Biopharmacy Prior Authorization. Along with this new form, please include any relevant medical records to ensure a timely determination on your Prior Authorization.

Are you looking for Ambetter? Please visit the Ambetter website.

We will continue to add resources to this section over the next several months.

Manuals

Inpatient Authorizations

Outpatient Authorizations

Assessments

Obstetrical Needs Assessment Form (PDF)

Behavioral Health Forms

Other