Prior Authorization

Instructions

Complete the Prior Authorization Form (below) and mail it to DXC Technology (see address below). Be sure to include supporting documentation for review.

Prior Authorization Form PDF 

Prior Authorization Instructions  

There can be multiple line items on a Prior Authorization Form but only one procedural code (PROC) or revenue code (REV) per line.

Mail to:             DXC Technology- Prior Authorization

                           P.O. Box 2010

                           Warwick, RI 02887-2010

Certain programs have specific guidelines and forms to obtain prior authorization. See the links below for more information on these programs or services:

Hospital

Pharmacy

Radiology Prior Authorization



 

 

 

 

 

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