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TREATMENT AUTHORIZATION FORM PLAN TYPE ROUTINE Commercial Secure Horizons EXPEDITED Secure Horizons only URGENT Commercial only For Routine/Standard Requests submit via fax to Prior Auth Fax Routine 866 718-6105 Urgent 866 718-6107 For Expedited Initial Determination Request call 800 762-8456 Option 1 Physician determines that standard request could seriously jeopardize the life or health of the enrollee or the enrollee s ability to regain maximum function. THIS PORTION TO BE COMPLETED BY...

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What is 866 718 6105 form?

866 718 6105 form is an official document used for filing specific information.

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The individuals or entities specified by the relevant authorities are required to file 866 718 6105 form.

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