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Pre-authorization Forms
For your convenience, the following forms may be used to facilitate the pre-authorization process.
Pharmacy prior authorization
Pharmacy prior authorization information and forms can be found at the RegenceRx
Physician Web site.
Investigational
services and supplies
Pre-authorization for investigational services and
supplies is required. Charges for investigational
services and supplies are denied as provider write-offs
unless the patient agrees in writing prior to receiving
services to be financially responsible for the charges.
Pharmacy prior authorization information and forms can be found at the RegenceRx Physician Web site.
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