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Prior authorization

Prior authorization is required for some therapies and medication. We don’t require PA for emergency care. You can also find out if a service needs PA by using ProPAT, our online prior authorization search tool. 

 

Search ProPAT

 

Questions?

Check out your provider manual (PDF). Or call Provider Relations at 1-866-638-1232 (TTY: 711).

Tips for requesting prior authorization

Tips for requesting prior authorization

A request for PA doesn’t guarantee payment. We can’t reimburse you for unauthorized services. Here’s the process for requesting PA:

 

  • Register for the Provider Portal if you haven’t already.

  • Verify member eligibility before providing services.

  • Complete and send the  PA request form (PDF) for all medical requests.

  • Attach supporting documents when you submit the form.

For details on the information and documents required to fill out a PA request form, you can refer to our PA request checklist (PDF).

How to request PA

 

You can request PA:

Online

Ask for PA through our Provider Portal.

By phone

Ask for PA by calling us at 1-866-638-1232 (TTY: 711).

By fax

Download and complete our PA request form (PDF). Then, fax it to us at 1-877-363-8120.

 

And be sure to add any supporting materials for the review.  

Need to request peer review?

To request a Peer to Peer review, call 1-833-459-1998

We don’t routinely conduct post-service reviews. You should follow procedures for requesting PA as defined in your provider manual, per your individual contract, on our website, or as per written notice. If you are denied a request for prior authorization, you can submit a claim and follow the provider appeal process.

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