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Web english authorized representative designation form use this form to select an individual or entity to act on your behalf. Web prior authorization/coverage determination form (pdf, 136 kb) prior authorization generic fax form (pdf, 201 kb) prior. Web ask your provider to go to prior authorization requests to get forms and information on services that may need approval before. Web place of treatment provider name, address and national provider identifier (npi) diagnosis code (s) procedure code (s), if. Refer to this list to see which drugs require prior authorization. Web slider menu blue shield of california submit eligibility & benefits overview verify eligibility create roster benefit summaries. Web blue cross complete pharmacy prior authorization guidelines.