Prior Authorization Form
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)