Forms Directory

Prior authorization forms — by payer

A practical directory of where to find each major payer's PA forms, plus the pitfalls our former payer-side specialists see most often.

Forms and policy criteria change frequently. Always confirm the current form on the payer portal before submission. The pitfalls below are drawn from our team's experience reviewing thousands of submissions inside payer organizations.

Cigna

Forms page CoverMyMeds / ePA portal

Common pitfalls

Submitting on outdated medical-necessity criteria — Cigna updates policy bulletins quarterly.
Missing recent labs or imaging (typically within 90 days) for specialty drug requests.
Forgetting peer-to-peer scheduling window after an initial denial (usually 5 business days).

Insider tips

Cite the specific Cigna Coverage Policy number in the clinical rationale.
Attach failed therapy history with dates and reason for discontinuation.
For specialty pharmacy, route to Accredo when applicable to avoid auto-redirects.

UnitedHealthcare

Forms page UHC Provider Portal

Common pitfalls

Using the commercial form for a Medicare Advantage member (or vice versa).
Skipping the Advance Notification step for procedures that don't require auth but do require notification.
Missing OptumRx vs. medical-benefit routing for injectables administered in-office.

Insider tips

Verify benefit (medical vs. pharmacy) in the eligibility check before selecting a form.
Use the Prior Auth and Notification tool inside the portal — faxed forms are deprioritized.
For oncology, route through OptumCare's clinical pathway to reduce review time.

Aetna

Forms page Availity Essentials

Common pitfalls

Submitting an incomplete Clinical Policy Bulletin (CPB) reference — Aetna requires the exact CPB number.
Missing weight-based dosing justification for biologics.
Using outdated diagnosis codes (ICD-10) that no longer map to the CPB criteria.

Insider tips

Include the patient's BMI and weight in the clinical notes for weight-based therapies.
Reference the most recent CPB revision date in your submission.
Submit appeals through Availity within 60 days; paper appeals take 2x longer.

Humana

Forms page Availity Essentials

Common pitfalls

Missing the Medicare Advantage-specific auth list — it differs from commercial.
Not attaching the prescriber's NPI and DEA on controlled substance requests.
Submitting urgent requests without the 'expedited' indicator, which defaults to standard timing.

Insider tips

Mark requests urgent only when clinical urgency is documented — abuse delays the queue.
Use Humana's online auth lookup to confirm a code requires PA before submitting.
For home health and DME, include the face-to-face encounter note within the prior 90 days.

Blue Cross Blue Shield

Forms page Availity / plan-specific portal

Common pitfalls

Treating BCBS as one payer — every state plan (Anthem, Highmark, BCBSIL, etc.) has its own forms and criteria.
Submitting to the local plan when the member is BlueCard out-of-area (must go to the home plan).
Using a generic medical-necessity letter instead of the plan's required template.

Insider tips

Always check the member ID prefix (alpha) to identify the home plan before submitting.
Use the plan's local medical policy library — federal/national policy does not always apply.
For BlueCard, submit through the local plan but reference the home plan's policy number.

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