Referrals & Authorizations

Referrals and Authorizations

In accordance with Health Plan requirements and Affinity policy, certain services require prior authorization before services can be rendered by Affinity Providers. The function of prior authorization is to verify member eligibility for the service, determine benefit coverage, and ensure the best provider selection, level and/or setting of care and to review the request for medical appropriateness using health plan, Affinity, or nationally accepted standards.

For more detailed information, consult the Provider Operations Manual, available on the Affinity Provider Portal.

• DMHC Prescription Drug Prior Authorization Form (PDF)
• Prior Authorization Form (2022)(PDF)
• Affinity Reopen Request Form (PDF)