Prior authorization requirements

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

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Behavioral health

Services billed with the following revenue codes always require prior authorization:

0240 to 0249 — All-inclusive ancillary psychiatric
0901, 0905 to 0907, 0913, 0917 — Behavioral health treatment services
0944 to 0945 — Other therapeutic services
0961 — Psychiatric professional fees

Fax all requests for services that require prior authorization to:

Inpatient: 1-844-430-6806
Outpatient: 1-844-442-8012


Services billed with the following revenue codes always require prior authorization:

0632 — Pharmacy multiple sources

Pharmacy resources:


Prior authorization is not required for physician evaluation and management services for members enrolled in Medicare Advantage.

Long-term services and supports

All services billed with the following revenue codes:

0023 — Home health prospective payment system
0570-0572, 0579 — Home health aide
0944-0945 — Other therapeutic services
3101-3109 — Adult day and foster care

All long-term services and supports require prior authorization. Please use the following contact information to submit your requests.

Submit LTSS prior authorization requests


Elective services

Elective services provided by or arranged at nonparticipating facilities always require prior authorization.

Provider tools and resources

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