CCP Prior Authorization Request Form - TMHP

F00012 Page 1 of 3 Revised: 09/17/2021 | Effective: 02/01/2022 CCP Prior Authorization Request Form Submit your prior authorization using TMHP’s PA on the Portal and receive request decisions more quickly than faxed requests. With PA on the Portal, documents will be immediately received by the PA Department, resulting in a quicker decision.

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