Southern Scripts

To submit a prior authorization online, please click the button below to use the web form.

PDF forms are available below to submit a prior authorization through fax.

Title
Appeal Request Form
 1 file(s)  496 downloads

sscripts

July 2, 2018

Download

FDA Medwatch Form
 1 file(s)  801 downloads

BCBSAL, BCBSFL, HiLab, HWMG, RxBenefits, sscripts

May 14, 2019

Download

Louisiana Uniform PA Form
 1 file(s)  137 downloads

sscripts

December 31, 2018

Download

Prior Authorization Form
 1 file(s)  3036 downloads

sscripts

February 22, 2019

Download