Precertification lookup tool

Please verify benefit coverage prior to rendering services. Inpatient services and nonparticipating providers always require precertification.

Please note:

  1. This tool is for outpatient services only.
  2. Inpatient services and nonparticipating providers always require precertification.
  3. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all noncovered services (i.e., experimental procedures, cosmetic surgery, etc.) — Refer to your Provider Manual for coverage/limitations.

* Services may be listed as requiring precertification that may not be covered benefits for a particular member. Please verify benefit coverage prior to rendering services.

To determine coverage of a particular service or procedure for a specific member:

  • Access eligibility and benefits information on the Availity Web Portal or
  • Use the Precertification tool within Availity or

Call Provider Services at:

1-844-396-2330

To request authorizations:

  • From the Availity home page, select Patient Registration from the top navigation.
  • Select Auth/Referral Inquiry or Authorizations.
  • See additional prior authorization/notification details  here

Provider tools & resources

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We look forward to working with you to provide quality services to our members.