Service Authorization/Notification Forms
Service Authorizations will only be issued when medical necessity for health care services and products is established and the services/products fall within the criteria or guidelines for the member's benefit set.
Please note: Please do not call to check on the status of the request or resubmit the same request as it creates larger volumes and actually slows down our response time. PrimeWest Health will call you with our determination within the allotted time frame. You are able to view the status of your request and be able to view and print letters.
Service Authorization Requests and Notifications
Effective October 31, 2020, PrimeWest Health Service Authorization requests and notifications must be submitted online through the PrimeWest Health provider web portal. After this date, letters will no longer be mailed. Letters can be viewed and printed in the portal.
If you are not already registered for the web portal, go to the Provider Web Portal – Request Access page and follow the directions to get access. If you are new to the online submission process and/or would like some assistance filling out the forms, please see the Tip Sheets below:
- Behavioral Health Homes (BHH)
- Children’s Residential Treatment Mental Health Treatment
- Getting Started
- Enteral Nutrition
- Hospital Admission/Discharge Notification
- How to Check the Status of a Completed Authorization Request
- How to Create a Non-Fillable PDF
- Intensive Residential Treatment Services (IRTS)
- Medical Service
- Mental Health Targeted Case Management (MH-TCM)
- My Facility Authorizations/Notifications
- Partial Hospitalization Program
- Psychiatric Residential Treatment Facility (PRTF)
- Restricted Recipient Program
- Substance Use Disorder Treatment and Services
If you are a new provider to PrimeWest Health (i.e., you have not contracted to be part of our network) and need to submit a claim, you must to submit additional documentation as noted in the New Facility Claim Requirements section of the PrimeWest Health Provider Manual.
If you are unable to access the online forms, Service Authorization requests and notification forms can be submitted using printable forms.
Dental Service Authorization Requests
Submit dental Service Authorization requests on American Dental Association (ADA) claim forms along with adequate and detailed documentation. See the Submitting Dental Service Authorization Requests section of the PrimeWest Health Provider Manual for more information.
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Updated_12/31/2025
