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Prior Authorization
EPSDT Prior Authorization
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Talking Points for HealthCheck Technical Assistance
Prior Authorization Provider Algorithm
HealthCheck Preventive Health Screening (PHS) Forms
Page 3 PHS Forms
BMS/EPSDT Prior Authorization Form
(for medical foods)
Prior Authorization Checklist and Fax Cover Sheet
Information Update-Billing Modifier
Regional HealthCheck Program Specialists
Any treatment plan that necessitates services requiring prior authorization must be documented during a HealthCheck initial, periodic or interperiodic screening.
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HealthCheck Program
Room 427
350 Capitol Street
Charleston, WV 25301
Phone: 1-800-642-9704