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Prior authorization
Providers need prior authorization (PA) for some outpatient care and planned hospital admissions. We don’t require PA for emergency care. You can find a current list of the services that need PA on the Provider Portal. You can also find out if a service needs PA by using ProPAT, our online prior authorization search tool.
Need more info?
Check out your Provider Manual. Or call Provider Services at 1-855-232-3596 (TTY: 711).
Tips for requesting PA
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Tips for requesting PA
A request for PA doesn’t guarantee payment. We can’t reimburse you for unauthorized services. You can make requesting PA easier by:
- Registering for the Provider Portal if you haven’t already
- Verifying member eligibility before providing services
- Completing the PA request form (PDF) for all medical requests
- Completing the PA request form for medical equipment/supplies (PDF)
- Attaching supporting documents when you submit the form
How to request PA
Here are the ways you can request PA:
By phone
Ask for PA by calling us at 1-855-232-3596 (TTY: 711).
By fax
Download our PA request form (PDF). Then, fax it to us at 1-844-797-7601. Be sure to add any supporting materials for the review.
Updates and guidelines
Here are some links with more info on PA requirements: