Precertification requirements

To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate.

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Participating and Nonparticipating Durable Medical Equipment Providers

For durable medical equipment (DME), outpatient rehabilitation (physical therapy/occupational therapy/speech therapy), pain management, home care, home infusion or hyperbaric treatment, and wound care, please fax to 1-866-920-8362.

Please fax to:

Fax:

1-866-920-8362

All Other Precertification Requests (Including Elective Inpatient or Outpatient Services) use the following:

Fax:

1-800-964-3627

Phone:

1-844-396-2330

Behavioral health

Services billed with the following revenue codes always require precertification:

0240–0249 all-inclusive ancillary psychiatric
0901, 0905–0907, 0913 and 0917 behavioral health treatment services
0944–0945 other therapeutic services
0961 psychiatric professional fees

Documents

Pharmacy

Services billed with the following revenue codes always require prior authorization:

0632 Pharmacy multiple sources
  Medicare and long-term services and supports

The following always require precertification:

  • Elective services provided by or arranged at nonparticipating facilities.
  • All services billed with the following revenue codes:
0023 home health prospective payment system
0570-0572 and 0579 home health aide
0944–0945 other therapeutic services
3101-3109 adult day and foster care

Related information

Provider tools & resources

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