Prior authorization for requested services

The primary coverage criteria of certain services must be established through a Prior Approval or pre-authorization process before they can be performed. Please refer to Availity Essentials portal, Health Advantage Coverage Policy or the member's benefit certificate to determine which services need prior approval.

What to include with the completed Prior Authorization Form "Use when a PA is required"

Please note: Not all services require prior authorization. You may contact customer service to determine what services require prior authorization. If the service does not require prior authorization, the service may be considered cosmetic, investigational, or may not be a covered benefit. We recommend you submit an Organizational Determination/Benefit Inquiry form. Failure to obtain any necessary authorizations may result in denial or reduction in benefits.

• Member Information
• Requested service(s)
• Name and telephone number of contact person
• Fax number to send determination
• Requesting / Performing Provider’s NPI or Provider ID
• Copy of member’s insurance card (front/back)
• Other Insurance Information
• CPT Code(s), ICD 10/HCPCS Code(s), Modifiers that are applicable
• Please use the most descriptive procedure and diagnosis codes
• Medical records to support requested services

Prior Authorization Code Lookup

Our tool is currently under construction.