Prior Authorization Form

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Prior Authorization Form
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Prior Authorization Form Instructions

Certain medical services require a Prior Authorization (PA) before they can be performed. Please choose one of the options below to submit your request.


Option 1 — Fastest Method

Submit Online via TECQ Partners Portal

For the quickest review and approval:

Visit:
https://payer.tecqpartners.com

  • Faster processing times
  • Real-time status tracking
  • Reduced delays due to missing information
  • Upload supporting documentation instantly
  • Immediate confirmation upon submission

✔ Recommended for clinics, providers, and high-volume requests


Option 2 — Fax Submission (Slower)

Fax the Attached Prior Authorization Form

You may submit by fax:

Fax: +1 (833) 585-5298

⚠️ Important: You must include the +1, or the fax will fail.

Fax submission may take longer due to:

  • Manual document review
  • Unreadable or incomplete fax images
  • Longer processing queue

Helpful Submission Tips

  • Complete all required fields before submitting
  • Attach labs, chart notes, imaging, or other clinical documentation
  • Verify member name and ID number
  • Include a provider contact name and return phone number
  • Mark requests as URGENT when medically necessary

Processing Timeframes

  • Standard requests: 2–5 business days
  • Urgent requests: reviewed as quickly as possible based on medical necessity
  • Incomplete submissions may delay processing

Need Assistance?

If you need help completing or submitting a PA request, please contact:
Provider Services: (your number here)
Email: (optional support email)