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Web submit a prior authorization. Web we would like to show you a description here but the site won’t allow us. Web we would like to show you a description here but the site won’t allow us. Web use this form to ask us to make a coverage determination and/or prior authorization. Web medical referrals & authorizations. Web please refer to this pdf document for a detailed list of services that require prior authorization and/or referral. Web use this tool to determine if prior authorization is needed for certain services and procedures. Once you have completed and signed this. For medical professional use only. 2022 inpatient prior authorization fax submission form (pdf) 2022 outpatient prior.