MAP and Charity Prior Authorization
Medical Access Program and Charity Program Prior Authorization Resources
Below is a collection of forms and resources to help providers easily access and download prior authorization forms, non-covered and plan limitations lists for MAP and Charity program members, and the Luminare Health provider user guide.
Forms and resources
- MAP Prior Authorization list | MAP Non Covered list | MAP Plan Limitations
Download these forms to view what CPT/HCPCS codes require a prior authorization, are not covered or have a plan limitation for MAP members. - Luminare Health Prior Authorization Form
Download this form to request a prior authorization for MAP & Charity members. - Charity Prior Authorization list | Charity Non Covered list | Charity Plan Limitations
Download these forms to view what CPT/HCPCS Codes require a prior authorization, are not covered or have a plan limitation for Charity members. - Luminare Health Provider User Guide
Download this document for an overview of the provider portal, how to locate patients, verify eligibility, review claim information and submit secure inquiries.
How to submit files and forms
Once the forms are downloaded and completed, please fax to 773-242-6028.