Prior authorization requirements

Providers will have the choice of using either Availity Essentials* or fax to submit prior authorization requests for all medical (non-pharmacy) services. Providers may also use Availity Essentials to check the status of a prior authorization request.

Prior authorization via fax

Inpatient authorization fax information

  • Physical health: 877-643-0671
    • Includes concurrent reviews for inpatient and admission request for skilled nursing facility, long term acute care, acute rehab, and nursing facilities
  • Behavioral health: 866-577-2184
  • Medicaid prior authorization: 800-964-3627
    • Includes precertifications for elective admissions

Outpatient authorization fax information

  • Physical health: 877-643-0672
    • Includes home healthcare, high dollar imaging, physical therapy, occupational therapy, speech therapy, per diem nursing, durable medical equipment, chiropractic, and acupuncture
  • Behavioral health: 866-577-2183
  • Medical injectables: 800-563-5581
  • Medicaid prior authorization: 800-964-3627
    • Includes outpatient surgeries

How to check prior authorization status with Availity Essentials

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

Don’t have an Availity Essentials account?


Need help with Availity Essentials?


OhioRISE (Resilience through Integrated Systems and Excellence) is a specialized managed care program for youth with behavioral health and multi-system needs. Aetna Better Health of Ohio will serve as the single statewide specialized managed care plan. For more information on OhioRISE, call their toll-free number, contact your provider services representative, or visit their site at , or via phone.

Contact OhioRISE


Call: 833-711-0773

Single pharmacy benefit manager (SPBM)

The SPBM provides more pharmacy choices for members and offers a more streamlined process for providers with a single preferred drug list and uniform clinical criteria for coverage. SPBM services include:

  • Processing pharmacy claims
  • Provide expert clinical knowledge to establish Preferred Drug Lists (PDLs)
  • Contract with pharmacies to ensure members have easier access to medications

For more information about the SPBM, call their phone number, contact your Provider Services representative, refer to your provider manual , or visit the Ohio Department of Medicaid's site.

Contact SPBM


Call: 833-491-0344


Pharmacy benefits for enrolled members are managed through the Ohio Department of Medicaid (ODM). ODM has contracted with a single pharmacy benefit manager (SPBM) to improve the administration of pharmacy benefits for managed care recipients and ensure transparency, accountability, and integrity to better serve Ohio Medicaid members and their healthcare providers.


Provider tools & resources

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