Prior Authorizations Forms

Changing Prior Authorization Process

Prior authorization processes will be changing for some of your patients. Banner Health has contracted with eviCore healthcare to provide services for members enrolled in Banner Medicare Advantage plans. Learn more at the links below!

Submitting for Prior Authorization

Please include ALL pertinent clinical information with your Medical or Pharmacy Prior Authorization request submission. To ensure that prior authorizations are reviewed promptly, submit request with current clinical notes and relevant lab work.

  • Banner Dual Medical Prior Authorization Form     English
  • Banner Prime and Banner Plus Medical Prior Authorization Form     English

For increased efficiency and advanced Prior Authorization experience, please submit your PA electronically! 

Electronic prior authorization (ePA) helps you spend less time on PA’s and more time on patients.

Some Electronic Health Records come equipped with ePA, but if yours doesn’t, there are online options such as Surescripts, CoverMyMeds, and ExpressPAth. 

Learn about and submit your PA to an online ePA portal here.

*Providers must use the “Expedited” request only when medically necessary.

  • Pharmacy Prior Authorization Form     English