Authorization Submission Instructions

Referral requests for Golden Coast MSO managed medical group patients may be submitted as follows.

Electronic Submission

In-Network, contracted providers may request portal access for electronic submission of referral requests. Instructions can be found here.

Fax Submission

Referral requests may be faxed on the forms available below. Please take care to utilize the appropriate authorization request by respective IPA / Medical Group.

Merit IPA

Authorization Request Form

Fax to (833) 606-1238

ChoiceOne IPA

Authorization Request Form

Fax to (888) 979-8896

Ascend IPA

Authorization Request Form

Fax to (877) 471-5478

Savior Physicians Network IPA

Authorization Request Form

Fax to (855) 862-7369

Apply Physicians Choice IPA

Authorization Request Form

Fax to (800) 783-8715