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Appeals and Grievances

Authorizations

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Pharmacy

NYS Medicaid Prior Authorization Request Form For Prescriptions

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In order to begin the program, members will need to have you complete this form.

Complete this form after the member completes the 6-month Weight Watchers program.

Instructions for large groups and IPAs with five or more providers on how to register for the secure provider portal.

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Last Updated On: 12/21/2015