Please complete the fillable pdf form below and fax all corresponding medical records to our office at 650-425-9468. Once the form has been received in our office the PHA staff will process all requests in the order they are submitted. You may expect a response for urgent authorizations within 24 hours or 48 hours for non-emergent authorizations.
Thank you for time and your request will be processed promptly. If you should have any questions please call 1-855-754-7271 to speak with a representative.
Pacific Health Alliance - Pre-Authorization Form