Electronic Prior Authorizations

For plans in Ohio and Minnesota, Providers may use SureScripts as a Prior Authorization Portal, which makes it easy for to submit fully electronic prior authorization requests right away.

There is no EHR needed, no technology integration, and no cost to providers — just quick and easy electronic prior authorizations.

 

You may also complete a  Prior Authorization Request Form to request a prior authorization.

If you are looking for a state-specific prior authorization request form not listed below, additional forms can be found here: State-Specific PA Forms »

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Wellfleet is the marketing name used to refer to the insurance and administrative operations of Wellfleet Insurance Company, Wellfleet New York Insurance Company, and Wellfleet Group, LLC. All insurance products are administered or managed by Wellfleet Group, LLC. Product availability is based upon business and/or regulatory approval and may differ among companies. ©2019 Wellfleet Group, LLC. All Rights Reserved.