Prior Authorization Forms

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Partnership HealthPlan Prior Authorization System (e-PA)

e-PA is a web-based electronic pharmacy​ TAR submission system. It is for pharmacy providers adjudicating claims through MedI​mpact, PHC's contracted Pharmacy Benefit Manager (PBM).

Use the prior authorization forms only if:

    • Your location is not contracted with MedImpact for claim
      adjudication (you bill PHC directly), or
    • Your location does not yet have access to PHC Electronic TAR, or
    • You are experiencing technical difficulties with internet access​​

Partnership HealthPlan Prior Authorization System (e-PA)

To get access to Partnership HealthPlan Prior Authorization System (e-PA)​, you must complete the training video that follows and fill out the questionnaire after you complete the tra​ining. 

When you complete the training, you will receive a secret key to use to register online for e-PA.