How to Fill Out and Submit a Medi-Cal Prior Authorization Form

A Medi-Cal prior authorization form takes one of two paths depending on what you are requesting. For medical services — surgeries, imaging, durable medical equipment, hospital stays, home health, long-term care — providers submit a Treatment Authorization Request (TAR) electronically through the eTAR web portal on the Medi-Cal Providers website. For prescription drugs, providers complete the DHCS 6560 form and send it through Medi-Cal Rx by fax, phone, mail, or the CoverMyMeds electronic portal. Either way, approval depends on documented medical necessity.

Which Form Applies to Your Request

The two tracks have separate submission methods, separate contact numbers, and separate review timelines.

Treatment Authorization Request (TAR): non-pharmacy services, including inpatient hospital stays, outpatient procedures, long-term care, durable medical equipment, and home health. Submitted electronically through the eTAR portal.¹
DHCS 6560 (Medi-Cal Rx Prior Authorization Request): prescription medications and pharmacy products. Faxable to 1-800-869-4325, mailable to the Medi-Cal Rx Customer Service Center, or submittable electronically through CoverMyMeds.²

One boundary to flag: if the patient is enrolled in a Medi-Cal managed care plan, the authorization request generally goes to the plan, not through fee-for-service channels. A fee-for-service TAR for a managed care enrollee will be denied unless you include a prior denial from the plan for the same services.³

What a Medical TAR Must Include

Gather the following before opening the eTAR portal, because the reviewer decides on what you submit:³

Patient identifiers: name, Medi-Cal Benefits Identification Card (BIC) number, date of birth, and gender.
Provider identifier: the treating provider’s National Provider Identifier (NPI).
Diagnoses: the principal diagnosis and any significant associated diagnoses.
A description of the medical condition that makes the services necessary.
Service details: the type, number, and frequency of services, identified by procedure code.
A signed prescription or inpatient doctor’s order from the treating physician or licensed practitioner.
Supporting medical records, diagnostic reports, and evidence of prior treatments that establish medical necessity.

DHCS reviews each TAR solely for medical necessity, and even when the request is justified, the agency approves only the lowest-cost covered item or service that meets the beneficiary’s medical needs.⁴

Submitting the eTAR

California requires providers to submit TARs electronically. Paper TARs are allowed only when the portal has been down for more than 72 consecutive hours and DHCS has specifically directed the provider to submit on paper.¹ There is no routine fax or mail alternative.

To get in, log in to the Medi-Cal Providers website, go to “Transactions,” and click “Online TAR Applications.” From there you can create a new TAR, update an existing one, check status, or view responses.³

Set the “Type of Service” field accurately — inpatient, outpatient, long-term care, or another category — because it determines which reviewing department handles the request. Describe the patient’s condition in language that lines up with the diagnostic evidence you are attaching. If a procedure code does not normally require a TAR but one is needed for a specific reason, select the special handling description “Cannot bill direct, TAR is required” in the Patient Information section.³

Attaching Supporting Documents

Records that will not fit into the eTAR data fields can be faxed to the dedicated attachment line at 1-877-270-8779. Every faxed attachment must have a completed TAR 3 Attachment form as the cover page so the system can match it to the correct eTAR submission.³ Label every page with the patient’s name and BIC number. Attachments without the cover form or without clear patient identification get delayed or separated from the request.

Retroactive TARs for Acute Hospital Days

When services have already been provided, you can submit a retroactive TAR for acute hospital days. The request must include a detailed discharge summary covering the reason for hospitalization, significant findings, procedures performed, the patient’s condition at discharge, and information given to the patient and family. A complete discharge summary in standard medical terminology lets DHCS consultants adjudicate the TAR faster.³

Submitting a Pharmacy PA on the DHCS 6560

Prescription authorizations go through a separate channel. Complete every applicable section of the DHCS 6560 (most recently revised March 2025) for a single beneficiary; multiple patients require separate forms.²

Pharmacy PAs can be sent four ways:

Electronic (fastest): CoverMyMeds at covermymeds.health, often with real-time determinations.
Fax: 1-800-869-4325.
Phone: 1-800-977-2273.
Mail: Medi-Cal Rx Customer Service Center, ATTN: PA Request, P.O. Box 730, Rancho Cordova, CA 95741-0730.

Attach chart notes, lab data, and any other clinical documentation that supports the request. For off-label use or doses that exceed FDA-approved limits, include peer-reviewed journal articles showing the proposed use is safe and effective for the patient’s age and diagnosis.² Incomplete submissions are returned, not held for more information, so a missing field means starting over.

When a beneficiary has an emergent need and is having difficulty getting a medication, the member or the healthcare team can request an emergency fill of up to a 14-day supply while the PA is being processed.⁵

Errors That Get a Form Rejected

Most TARs that fail do so on technical errors before a reviewer ever reaches the clinical merits. Watch for these:³

Procedure or drug code on the TAR that does not exactly match the code on the eventual claim.
Authorized quantity that does not match what you later bill, or claims billed for more units than the TAR approved.
Wrong NPI, which causes an automatic mismatch.
Duplicate TAR Control Numbers — once a TAR form has been faxed, reusing that form or a copy of it generates a duplicate the system rejects.
Missing Pricing Indicator; it must appear as the 11th digit of the TAR Control Number on claims, or the claim is denied.
Mixing TAR-authorized services with services that do not require a TAR on the same claim; those must be billed separately.

A denied or cancelled TAR cannot be updated. The system rejects the update, and you have to submit a new TAR.

After You Submit

Pharmacy and medical requests move on different clocks. DHCS processes pharmacy PA requests and returns a decision within 24 hours, as required by Welfare and Institutions Code Section 14133.37.⁶ For non-pharmacy TARs, DHCS does not publish a standard turnaround time; actual processing at Medi-Cal field offices has historically averaged 9 to 12 working days.

Three outcomes are possible once a consultant reviews the request:

Approved. The services are authorized and the provider can proceed and bill accordingly.
Deferred. The reviewer needs more information. The provider gets instructions and has 30 days to respond; if the 30 days lapse, DHCS denies the TAR automatically.
Denied or modified. DHCS issues a Notice of Action (NOA) to the beneficiary with a copy to the provider, explaining the decision and the regulatory basis.³

If the Request Is Denied

A denial is not final. Beneficiaries can request a State Fair Hearing within 90 days of the date on the denial notice. Between 90 and 180 days, the hearing judge may still accept a late request if the beneficiary shows good cause for the delay.⁷

File the request through any of these channels:

Online: cdss.ca.gov/hearing-requests.
Phone: State Hearings Division at 1-800-743-8525 (TTY: 1-800-952-8349).
Fax: 833-281-0905.
Email: scopeofbenefits@cdss.ca.gov.
Mail: California Department of Social Services, State Hearings Division, P.O. Box 944243, Mail Station 9-17-37, Sacramento, CA 94244-2430.

Include the beneficiary’s name, BIC number, address, phone number, the reason for the appeal, and any language or accommodation needs for the hearing.⁷

Keeping Services During the Appeal

A beneficiary already receiving a service or taking a medication that is being reduced or terminated can keep receiving it while the appeal is pending, but only by requesting the hearing within 10 days of the NOA date and specifically asking for “aid paid pending” on the request form.³ That 10-day window is strict. Miss it, and the appeal can still go forward within 90 days, but the service or medication stops in the meantime.

For pharmacy denials, the provider has another option: submit a clinical appeal to DHCS for any PA that was denied within the past 180 days.²

What Changes in 2026

Beginning January 1, 2026, the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) sets new federal deadlines on Medicaid programs, including Medi-Cal. Payers must return prior authorization decisions within 72 hours for urgent or expedited requests and within seven calendar days for standard requests. The rule also requires payers to give specific reasons for any denial and to publicly report prior authorization metrics.⁸ In practice, that should pull non-pharmacy medical TAR decisions well under the historical 9-to-12-working-day average at field offices.

1
Legal Information Institute. California Code of Regulations Title 22 51002.5 – Submission of Electronic Treatment Authorization Requests (eTARs)
2
Medi-Cal Rx. Medi-Cal Rx Prior Authorization Request Form
3
Medi-Cal Providers. TAR Overview
4
New York Codes, Rules and Regulations. California Code of Regulations 22 51003 – Treatment Authorization Requests (TARs)
5
Health Plan of San Joaquin. Reminder – Medi-Cal Rx Emergency Fill Prescriptions
6
Medi-Cal Rx. Transitioning Medi-Cal Pharmacy Services from Managed Care to FFS FAQs
7
Medi-Cal Rx. State Fair Hearing Request Form
8
Centers for Medicare & Medicaid Services. CMS Interoperability and Prior Authorization Final Rule CMS-0057-F