Quick Authorization Form (QAF)

For those services included on the SHP Quick Authorization Form (QAF) (see the Forms Section of this handbook) a referral is NOT required. Primary Care Physicians (PCP’s) can refer a member to a  participating specialist and to many frequently requested services and procedures at free-standing facilities with the Simply Healthcare Plans Quick Authorization Form (QAF) without contacting the health plan for prior authorization.

IMPORTANT NOTE: Communication with the Plan prior to the provision of care is not necessary when using the QAF; however, all inpatient services, outpatient hospital services (including diagnostics), and ASC services do require an authorization

Prenatal care referrals are NOT to be made using the QAF.

**The QAF form is not valid for any inpatient or outpatient hospital services or for any consultations or procedures not listed on the form, or for out-of-network providers.**

The PCP or specialist ordering the consultation or test is required to fax or mail a copy of the  completed QAF to the participating provider or facility that will be providing the service(s), or to give a copy to the member so that it is presented at the time of the service

Services that Do NOT Require Prior Authorization or QAF:

 Family Planning

 Participating Office/free standing laboratory tests at labs consistent with CLIA guidelines

 Emergent transportation services

 Urgent or emergent care at participating Urgent Care centers or any Emergency Room  County Health Departments (CHD), Federally Qualified Health Centers , Rural Health Clinics and federally funded migrant health centers when providing:

 Vaccines

 STD diagnosis/treatment

 Rabies diagnosis/immunization

 Family planning services and related pharmaceuticals

 School health services and urgent services

*NOTE: If the member receives Family Planning Services from a non-network Medicaid provider, the Plan will reimburse the provider at the Medicaid reimbursement rate, unless another payment rate is negotiated.