Prior Authorization Reconsideration (Medicaid fee-for-service) Form NameForm NumberMedicaid (fee-for-service) Prior Authorization Reconsideration Request (PDF)HHS Form 1322
Prior Authorization Reconsideration (Medicaid fee-for-service) Form NameForm NumberMedicaid (fee-for-service) Prior Authorization Reconsideration Request (PDF)HHS Form 1322