Prior Authorization Lookup Tool
Availity’s Precertification Lookup Tool helps you know if an outpatient procedure requires prior authorization.
Please verify benefit coverage prior to rendering services. Inpatient services and non-participating providers always require prior authorization.
- This tool is for outpatient services only.
- Inpatient services and non-participating providers always require prior authorization.
- This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all non-covered services (for example, experimental procedures, cosmetic surgery, etc.) — refer to your Provider Manual for coverage/limitations.
* Services may be listed as requiring prior authorization that may not be covered benefits for a particular member. Please verify benefit coverage prior to rendering services.
To determine coverage of a particular service or procedure for a specific member, do one of the following:
- Access eligibility and benefits information on the Availity Essentials.
- Use the Prior Authorization Tool within Availity.
- Call Provider Services at 1-833-388-1406 from 8 a.m. to 9 p.m. CT, Monday through Friday.
To request authorizations:
- From the Availity home page, select Patient Registration from the top navigation.
- Select Auth/Referral Inquiry or Authorizations.
Provider Tools & Resources
- Roster Automation Standard Template
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- Learn About Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Member Eligibility & Pharmacy Overview
- Policies, Guidelines & Manuals
- Training Academy
- Pharmacy Information
- Electronic Data Interchange (EDI)
- Quality of Care Form