DME Prior Authorization FormProviders should use this form when requesting authorization for durable medical equipment.Authorization Request for Inpatient and Outpatient ServicesProviders should use this form when requesting authorization for a procedure to be performed in an IP/OP or OBS setting.If you are a PCP and have members who would like to notify Virginia Premier of their wish to change their PCP, please print the PCP Change form and have members complete this form and fax to Virginia Premier. I agree to notify Virginia Premier System immediately in the event that my network access has been compromised in any way and in the event of unauthorized use or disclosure of any information obtained from the Virginia Premier System network. I agree to keep confidential all information related to Virginia Premier System business, including, but not limited to, quality and risk management activities as well as other confidential or personal information concerning the medical, personal, or business affairs of Virginia Premier System and its members.
This includes full compliance with the Health Insurance Portability and Accountability Act of 1996 (‘HIPAA’), the HITECH Act, and the Virginia Health Records Privacy Act, and applicable regulations to these laws.
With respect to all information viewed or obtained from this site, I agree to comply with all applicable federal and state laws regarding the confidentiality and integrity of health and medical records. I certify I am a health care provider, an employee of a health care provider, a business associate of a health care provider, or an employee of a business associate, and the purpose of my access to any Virginia Premier System is related to the provision or payment of health care services.
Addiction and Recovery Treatment Servicesīy logging in to this portal, I affirm that I have read, understand and agree to abide by the following terms and conditions:.Behavioral Health and Addiction Recovery.Prescription Drug Coverage Determination Request.Virginia Premier Kaiser Permanente Providers.Virginia Premier/Kaiser Permanente Members.Virginia Premier/Kaiser Permanente Elite Individual Plan.