Prior authorization requirements

Wellpoint Iowa, Inc. accepts prior authorization requests via phone, fax or Interactive Care Reviewer (ICR), a secure utilization management tool available in Availity. With ICR, you can submit or check status of a request, attach clinical documentation, and auto-authorize more than 40 common procedures. You may also use Availity’s Maternity Module to report a member’s pregnancy.

Check out our Prior authorization lookup tool to determine prior authorization requirements or contact Provider Services for assistance.

Log in to Availity

Don't have an Availity account?

Behavioral health (Medicaid only)

View Medicaid behavioral health benefits, including prior authorization requirements, on our Behavioral Health page.

Submit a Medicaid behavioral health request

Inpatient fax:


Outpatient fax:



Be sure to check the applicable formulary before prescribing drugs under the pharmacy benefit for Wellpoint members.

Iowa Medicaid Preferred Drug List (PDL)

Submit a Medicaid pharmacy request

Visit our Pharmacy information page for detailed information on submitting a pharmacy prior authorization request.

Long-term services and supports (LTSS)

Prior authorization is required for LTSS services. Please refer to the Medicaid provider manual or visit our LTSS page for more information.

Submit a Medicaid LTSS request




Certain Medicare services and procedures require prior authorization from Wellpoint for participating and nonparticipating PCPs and specialists. Refer to the Prior authorization lookup tool or the Medicare provider manual for more information.

Submit a Medicare request




Home health, durable medical equipment, therapies and discharge planning: 1-888-235-8468
Concurrent clinical review documentation: 1-888-700-2197
Behavioral health (inpatient): 1-844-430-1702
Behavioral health (outpatient): 1-844-430-1703
Initial admission notifications and all other services: 1-800-964-3627

Provider tools & resources

Interested in becoming a provider in the Wellpoint network?

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

Join Our Network