Prior Authorization Form Download | RxBenefits

Prior Authorization Form and Status Check

Download Prior Authorization Form

Check Status on your PA Request

HWMG Members Prior Authorization Form

Prior Authorization Status FAQs

Who can use Prompt PA to check the prior authorization status?

Members
Providers
Pharmacies

What status details will be available on Prompt PA?

Approved
Denied
In progress

What information do you need to check the prior authorization status?

Member ID
- This can be located on your Medical ID card (if you have a combined medical and pharmacy card), on your Pharmacy card, or by calling the member services Prior Authorization line at 888.608.8851.
Prior Authorizations (EOC) ID: a unique number assigned to the PA request.
- You can find this by calling the Prior Authorization line at 888.608.8851 or
- You may have received a letter regarding this particular prior authorization. If so, your EOC will be included on the letter.
First name , last name, and date of birth of the member