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PDL Reference Tool

All of the PDL's are in .pdf format. You must have Adobe Acrobat Reader to view the forms. If you do not have Adobe Acrobat Reader, we recommend downloading and installing the latest version.

  • April 2024 PDL
  • July 2024 PDL
  • October 2024 PDL
  • January 2025 PDL
  • April 2025 PDL

New Form Submission

You can now fill out and submit your Prior Authorization and Override requests online.

Submit Request Online

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al_pa@acentra.com
P: 1-800-748-0130
F: 1-800-748-0116

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