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
Fax all requests for services that require prior authorization to:
Inpatient:
844-462-0024
Outpatient:
844-462-0027
Prior authorization always required.
These behavioral health 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
Prior authorization always required.
These pharmacy codes always require prior authorization:
| 0632 | Pharmacy multiple sources |