Attention Providers: Change Healthcare Update Change Healthcare (CHC) can resume submitting claims to RI Medicaid. This means if you are doing business with CHC, they can submit your claims to RI Medicaid and CHC can now resume downloading your 835/277unsolicited transactions.Please reach out to your clearing house representative with any questions you may have regarding the submissions. You can also reach out to riediservices@gainwelltechnologies.com.
Pharmacy Prior Authorization Program Prior Authorization (PA) Cheat Sheet Forms Prior Authorization for Non-Preferred Drug Form PA01 - Modafinil PA02 - CNS Stimulants PA04 - Weight Loss PA05 - Follicle Stimulation PA06 - Growth Hormone PA09 - Botulinum Toxins PA10 - Agents Treating Pulmonary Hypertension PA11 - Fuzeon PA16 - Chronic Idiopathic Constipation PA17 - Qualaquin PA18 - Megace ES PA20 - Pradaxa PA21 - Xifaxan (550mg) PA22 - Treatment for Hepatitis C Sample Patient Contract for receiving treatment for Hepatitis C PA23 - Opioids PA24 - Yescarta_Kymriah PA24 - Yescarta_Kymriah Coverage Guidelines for Modified T-Cell Therapies General Pharmacy Prior Authorization Form