Create Pre-Certification - TPA Exchange Healthcare

Member Name:

Eligibility Status:

Please be advised that the standard turnaround time for prior authorization requests is 5-7 business days.

To avoid delays in processing, we kindly request that you:

Upload all pertinent medical records at the time of submission.
Do not submit handwritten medical records, as these will not be accepted.
Retain a copy of the Case ID # provided upon submission for your records and future reference.

Incomplete documentation or missing records may result in processing delays or denial of the request.

Thank you for your cooperation.

Member Info

Enter the Member ID or SSN and remaining details to proceed

SSN or Member Number

Date of Birth

Provider NPI

Facility NPI

Provider Name

Facility Name

Provider Phone

Facility Phone

Provider Fax

Facility Fax

Date Of Service

In / Out Patient

In Patient Out Patient

Click or Drop here to Upload Documents

All type supported (Max Size: 30MB)

Your Upload will show up here once you add them.