How to fax a prior authorization or appeal and prove delivery

Fax a prior authorization on the payer's form where it has one, to the number printed on it, and keep the delivery record beside the payer's reference number: CMS-0057-F gives Medicare Advantage, Medicaid and CHIP payers 7 calendar days, or 72 hours when expedited, from the day they receive the request, fax included.

What is the best way to fax a prior authorization?

The best way to fax a prior authorization is five steps in order: the payer's form, one fax with the support behind it, the payer's own cover sheet, a delivery record, and a tracked reply with the payer's reference number.

1. Use the payer's prior authorization form where it has one, and the fax number printed on it.
2. Send the form and its supporting documentation as one fax, in the order the payer asks.
3. Fill in the payer's cover sheet as designed, or keep patient identifiers off a cover page where none is prescribed.
4. File the delivery record with the request the day it goes out.
5. Track the reply, and record the payer's reference number beside the delivery record.

CMS-0057-F keeps fax in the process. CMS says the rule's decision deadlines apply whether a request arrives through the API, a portal, fax, phone or another channel, and that decisions may come back by portal, fax, email, mail or phone. Payers still steer requests: Humana Military's TRICARE East tip sheet calls online submission the preferred method and lists fax for non-urgent requests from facilities without internet access, and UnitedHealthcare's fax option is only available for commercial plans in Massachusetts, Nevada, New Mexico and Texas, as covered in the UnitedHealthcare prior authorization fax number.

What goes in a prior authorization fax?

A prior authorization fax carries the payer's request form, signed and dated where it asks, followed by the clinical documentation that supports it, in the order the payer sets.

The table shows the documents and order that official programs name.

Use the payer's form where it has one. The Texas form NOFR001 says an issuer may already have filled in its Section I submission details on the copy posted on its website. HIPAA counts preauthorization as a payment activity (45 CFR 164.501), and the minimum necessary standard in 45 CFR 164.502(b) asks for reasonable efforts to limit the packet to what the request needs.

The same order covers psychological testing, intensive outpatient care and medications through a pharmacy benefit. For a Part D request that involves an exception, CMS says the decision clock does not begin until the plan receives the prescriber's supporting statement, so that statement belongs in the first fax.

What stays off the cover sheet?

What stays off the cover sheet depends on whose cover sheet it is: a payer's own cover sheet is filled in as designed, and where none is prescribed, patient identifiers stay off the cover page.

Official cover sheets differ. First Coast's hospital outpatient cover sheet starts with the beneficiary's last name and also takes the Medicare ID and date of birth, Wisconsin's F-01176 has a PA details block for the member's name and PA number, and Cigna's intake cover sheet asks only for the sender's name, phone number and fax number. First Coast asks for one cover sheet for each request with documentation, and Washington's barcode sheets let ProviderOne scan the pages and update the current record.

Every fax sent from a computer must also carry the date and time it is sent and an identification of the sender, in a margin of each page or on the first page, under 47 CFR 68.318(d). The fields a cover sheet can carry are in HIPAA fax cover sheet requirements.

How do you prove the payer received it?

A delivery record proves the payer's fax line accepted the pages at a recorded time, and only the payer can confirm that it indexed the request and assigned its reference number.

The table shows what a delivery record answers and who confirms the rest.

The recorded time matters because the clock runs from receipt. CMS's prior authorization FAQ says the decision clock starts when the payer receives the request, runs in calendar time, and does not stop or restart when the payer asks for documentation it had not told the provider about when the request was sent. Under ITU-T Recommendation T.30, the receiving machine sends a Message Confirmation signal when a complete message has been satisfactorily received. How to read a delivery record is in how to tell if a fax went through.

How long does the payer have to decide?

The payer has 7 calendar days for a standard request and 72 hours for an expedited one under CMS-0057-F, and other programs set their own clocks, from 24 hours for an expedited Part D request to 15 days for an employer plan's pre-service claim.

The table shows the decision clocks and appeal windows by program.

The CMS-0057-F clocks are maximums. CMS's chart marks every standard and expedited limit except state Medicaid fee-for-service's 72-hour expedited limit as open to an extension of up to 14 calendar days, and its example puts an expedited request received at 1:00 AM Sunday due by 1:00 AM Wednesday. Compliance started January 1, 2026; for Medicaid managed care the 7-day limit applies to rating periods that start on or after that date. Qualified Health Plan issuers on the federal exchanges are excluded from these clocks, and drugs sit outside the rule.

Drugs stay outside CMS-0057-F for now: CMS-0062-P, released April 10, 2026, is a proposal that would set drug decision timeframes with compliance dates beginning October 1, 2027. In the hospital outpatient program, decisions and their UTNs stay valid for 120 days, counting the decision date as the first day. Where to fax a Part D reconsideration is in the Medicare Part D reconsideration fax number.

How do you appeal a denial by fax, and by when?

A prior authorization denial is appealed on the plan's own appeal path within its window: 60 calendar days from receipt for a Medicare Advantage reconsideration (65 calendar days from the date of the notice, as CMS's own pages put it), 60 calendar days for a Medicaid managed care appeal, at least 180 days for an employer plan and 180 days for a HealthCare.gov plan.

Every denial from a CMS-0057-F payer must state a specific reason, whatever channel the request used, and the appeal answers that reason. A Medicare Advantage reconsideration counts as filed on the date the plan or the delegated entity named in the written determination receives it, and the determination itself is presumed received 5 calendar days after its date. HealthCare.gov plans must finish an internal appeal within 30 days for a service not yet received and 60 days for one already received.

Two paths work differently. In traditional Medicare's hospital outpatient program, a non-affirmed request is not an initial determination and would not be appealable; the provider can resubmit it an unlimited number of times. The 120 calendar days for a Medicare redetermination under 42 CFR 405.942 apply to a denied claim, counted from receipt of the initial determination. For an urgent employer-plan appeal, the federal claims rule has the plan and the claimant exchange information by telephone, facsimile or another similarly fast method. The Texas form NOFR001 is not for appeals.

What gets a prior authorization rejected or delayed?

A prior authorization is rejected or delayed when it goes on the wrong form or to the wrong line, arrives without the documentation the payer needs, or misses the urgent path it qualified for.

• A form used for the wrong purpose: the Texas form excludes appeals, eligibility checks, coverage verification, payment guarantees, questions about whether a service needs prior authorization, and prescription drugs.
• A missing required attachment, such as Wisconsin's PA/IOP for intensive outpatient care, or a Part D exception sent without the prescriber's supporting statement.
• An urgent request not marked as one. A Medicare Advantage plan must expedite when a physician indicates the standard timeframe could seriously jeopardize the enrollee's life, health or ability to regain maximum function, and the request can be oral or written (42 CFR 422.570); the Texas form lists a life-threatening condition, a current hospitalization and treatment after an emergency is stabilized.
• A channel the payer does not take for that plan, such as UnitedHealthcare's fax option outside its four commercial states.
• An expired decision, since a hospital outpatient UTN is valid for 120 days.

How do you send and track prior authorizations from a HIPAA fax account?

A Fax Pigeon account sends the packet as one PDF from the browser or from email, and every delivered fax gets delivery proof to file beside the payer's reference number. A cover sheet is optional, so the payer's own cover sheet can go first in the PDF. Replies to the practice's own number on a paid plan land in the shared inbox, where each one can be assigned to the person who owns the request. Every plan includes a signed BAA at signup, the written agreement 45 CFR 164.502(e) requires with a vendor that handles PHI.

* Official sources (CMS, the eCFR, HealthCare.gov, the Texas Department of Insurance, Humana Military) were read on October 19, 2026. Fax Pigeon prices and plan terms as of October 19, 2026.