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Prior authorization forms are a critical part of the healthcare system, requiring providers and patients to obtain approval from insurers or government programs before certain services, treatments, or medications are covered. These forms document medical necessity, clinical eligibility, and relevant diagnostic information so that payers can make informed coverage decisions. Whether it's requesting coverage for ABA therapy for a child with autism, getting approval for a specialty medication like Mounjaro or Wegovy, or seeking an exception for out-of-network care, completing these forms accurately and completely is essential — delays or errors can hold up treatment and affect patient outcomes.

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Arizona Form 285-I · Filled by Instafill.ai in 9 sec

Arizona Form 285-I filled by Instafill.ai

About prior authorization forms

These forms are used by a wide range of people: healthcare providers submitting requests on behalf of patients, case managers coordinating complex care, physicians prescribing specialty drugs, and even patients navigating their own insurance coverage. Some forms in this category also extend to related authorization needs, such as tax disclosure authorizations or fertility clinic intake packets that include insurance consent components. What they share in common is the need for precise, complete information submitted in a timely manner.

Because these forms often involve detailed clinical codes, provider identifiers, and member information, filling them out can be time-consuming and error-prone. Tools like Instafill.ai use AI to fill these forms in under 30 seconds, helping providers and patients submit accurate, complete requests without the usual administrative burden.

Forms in This Category

Form Name Pages
1. Arizona Form 285-I, Individual Income Tax Disclosure/Representation Authorization Form 1
2. Center for Infertility & Reproductive Surgery – New Patient Questionnaire and Patient/Guarantor Statement (Brigham and Women’s Hospital, Department of Obstetrics and Gynecology) 4
3. The Department of Medical Assistance Services Applied Behavior Analysis Preservice Service Authorization Request Form (Effective Dates of Service 09/01/2025 and after) 8
4. Prior Authorization (PA) Request Form – Adult Palliative Care (Alameda Alliance for Health) 5
5. Alameda Alliance for Health Prior Authorization (PA) Request Form – Adult Palliative Care 5
6. California/National Apartment Association Official Form B-15, Rental Application for Residents and Occupants (May 2015) with Application Agreement 5
7. Manulife Group Benefits Drug Prior Authorization Form – Mounjaro (Tirzepatide) (GL5197E) 4
8. Manulife Group Benefits Drug Prior Authorization Form (Ozempic/Semaglutide) – GL5197E 4
9. Out-of-Network Pre-Authorization and Exception Request Form 2
10. Out-of-Network Pre-Authorization and Exception Request Form 2
11. Manulife Group Benefits Drug Prior Authorization Form (Wegovy/Semaglutide) – GL5197E - MLI (08/2025-WEGOV) 6
12. Applied Behavioral Analysis (ABA) Prior Authorization Request Form (Health Net Behavioral Health Autism Center) 1
13. Applied Behavioral Analysis (ABA) Prior Authorization Request Form (Coordinated Care) 2
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