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Otherwise, list all of the. For full ba online provider services, such as claim status checks, member eligibility,. If authorization type does not equal ops or pi then list si name; Web arkansas prior authorization request form please return this completed form and supporting documentation by fax to:. Web find the most common documents and forms for filing claims or reviewing your coverage with blueadvantage medicare. Web the purpose of this form is to request a prior authorization for outpatient services and part b drugs. Please fax this completed form to.