Medical Forms

We’ve simplified our prior authorization forms and fax lines to make submissions easier. Two new forms—one for inpatient and one for outpatient requests—have replaced all authorization forms previously available here.

Authorization/Extension Requests

NEW: Inpatient Authorization Request
NEW: Outpatient Authorization Request
Continuity of Care - Members in a Maryland Based Plan (PDF)
Continuity of Care - Provider Not in Network (PDF)
Maryland Uniform Treatment Plan Form