Prior authorization requirements
To request or check the status of a prior authorization request or decision for a plan member, access our Interactive Care Reviewer (ICR) tool via Availity. Once logged in, select Patient Registration | Authorizations & Referrals, and then choose Authorizations or Auth/Referral Inquiry, as appropriate.
You may also use Availity’s Maternity Module to report a member’s pregnancy.
Don’t have an Availity account?
Services billed with the following revenue codes always require prior authorization:
0240–0249 — All-inclusive ancillary psychiatric
0901, 0905–0907, 0913, 0917 — Behavioral health treatment services
0944–0945 — Other therapeutic services
0961 — Psychiatric professional fees
Pharmacy
Check our Preferred Drug List (PDL) - English
Services billed with the following revenue codes always require prior authorization:
0632 — Pharmacy multiple sources
Related information
Provider tools and resources
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