Information for SWMC Providers and members:

• SWMC Prior Authorization Request Form
  • This form is to be used only for the SWMC Employee Health Plan members. CUP will not accept this form for referrals or prior authorization requests for CUP members.
• Injectable/Infusion Prior Authorization List - Effective 5/1/2009
  • This is a list of drugs that require authorization if they are administered in a physicians office or a facility.
• Prior Authorization Requirements - Updated 11/1/2009
  • This is a list of services that require authorization to determine medical necessity or plan benefit limitations.
• SWMC HIPAA Release Form
• Synagis Injection Criteria