Prior authorization

Locate authorization teams and submission faxes. Medical, pharmacy and delegated reviews can follow different routes.

prior authorization

THP/Trinity Health Plan — prescriber-services drug coverage determination

Official page read

Phone866-785-5714

Questions regarding the prior authorization process for this specific prescriber-services coverage-determination form.

Fax

855-633-7673

Completed and signed 2026 Prescriber Services BD-13 coverage-determination form.

Published hours

Not published in this record

Product, plan and location

medicare advantage
National contact — confirm product and location

Mailing address

Not researched for this route

THP Medicare is Trinity Health Plan. The 2026 BD-13 v1 010126 form is for Drugs Given Incident To Prescriber Services, labelled Coverage Determination. Fax completed signed forms to 855-633-7673; 866-785-5714 is explicitly for questions about the prior authorization process. Current Trinity Health Plan of Michigan and Mount Carmel MediGold provider manuals link this exact form. It does not establish appeal/redetermination intake, a universal Medicare Part D route, or a Part B/Part D classification for every request. Confirm the member plan and applicable form before use. US denotes national telephone scope only, not nationwide plan availability.

View source ↗ · Source checked 2026-10-22 · Trinity Health Plan identity and Medicare Advantage plans ↗ · Trinity Health Plan of Michigan provider manual ↗ · Mount Carmel MediGold provider manual ↗

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Locate authorization teams and submission faxes. Medical, pharmacy and delegated reviews can follow different routes.

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