Provider – Request for Authorization

Please fax Requests for Authorization (RFAs) to 1-702-671-7676.

EMPLOYERS Request for Authorization Form

Physicians and Chiropractors Progress Report

For the following states:

California
California Request for Authorization Treatment Request Form (DWC form RFA)

Texas
Fax Genex at 1-800-287-4028

Massachusetts, New York
Requests should be emailed to Arbicare
Email: intake@arbicare.com
Fax: 1-404-631-6387
Phone: 1-800-716-8295