Authorization Submission Instructions

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

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. 

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Merit IPA

Authorization Request Form

Fax to (833) 606-1238

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ChoiceOne IPA

Authorization Request Form

Fax to (888) 979-8896

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Ascend IPA

Authorization Request Form

Fax to (877) 471-5478

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Electronic Submission

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

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