FAX FORM TO 212-402-4468 FOR INPATIENT REVIEWS OR DISCHARGES.
FOR ALL OTHER REQUESTS FAX FORM TO 718-517-2709.
This standard form should be utilized to submit prior authorization request to VCMAX along with the necessary clinical documentation to support the request. Incomplete submissions will be returned unprocessed. If you have any questions, please call 800-469-6292.
Please attach clinical documentation to support the request. I.e. clinical notes, lab results, x-rays etc. Durable Medical Equipment requires a physician signed prescription and letter of medical necessity.