Questions? Call (888) 705-5274
If you are submitting additional documents in regards to a previous re-authorization request, please complete the required fields and scroll down to the Additional Information section.
Add visits for a discipline already in the home
Add check for discipline(s) that are NOT already in the home
Extend a service period for which not all visits could be completed timely
Please enter any comments
RA notification to agency confirms receipt of determination with approved visits. Should you disagree with approval, please notify PHCN UM Department at (888) 705-5274. Should a material change in member status occur, submit an additional request with pertinent clinical documentation.