San Francisco Health Plan: Providers: Provider Resources: Download Forms

Providers: Provider Resources: Download Forms

Download Forms

Choose a form:

Authorizations

Prior Authorization Request Form

Services Requiring Prior Authorization

Pharmacy Prior Authorization Request Form

Fax completed pharmacy prior authorization request forms to InformedRx at 1 (800) 945-1815 or submit them online at www.nmhcrx.com

Below are the links to authorization forms for Anthem Blue Cross:

Anthem Blue Cross Pharmacy Authorization Form
Anthem Blue Cross Medical Services Authorization Form