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Pre-Authorization Form

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

 

 

Valley Health Plan Providers

Prospective providers to the Valley Health Plan network, Please complete the pdf packet below and transmit to the addresses within.

Valley Health Plan Provider Contract Packet