Prior authorization

Aetna Better Health Premier Plan MMAI require prior authorization for select acute outpatient services and planned hospital admissions. Prior authorization is not required for emergency services. 

If the member is covered, services and those requiring prior authorization change, will receive at least 60 days advance notice via provider newsletter, e-mail, updates to this website, letter (U.S. mail), telephone call or office visit.

Participating providers can now check for codes that require prior authorization via our Online Prior Authorization Search Tool.


If you are a non-participating provider, 100% of all services require a Prior Authorization.

Exceptions:

Emergency, Radiology, Anesthesiology, and Pathology (ERAP) specialties do not require authorization when billed with POS 21, POS 22, POS 23, or revenue code 0450 for all providers.

Emergency room services billed with POS 23 or bill type 131 with revenue code 0450 do not require an authorization for all providers.


Remember, prior authorization is not a guarantee of payment. Unauthorized services will not be reimbursed.

To find out what services require authorization or check on the status of an authorization on the provider portal, please visit our provider secure web portal. For more information about prior authorization, please review the Provider Manual.

You must be registered for the Provider Web Portal in order to have access. Please click below to either register or log in.

Certain acute outpatient services and planned hospital admissions require prior authorization before the service can be covered for the member.
For more information, please contact a Provider Relations representative at 1‑866‑600-2139 for more information.

When you request prior authorization for a member, we’ll review it and get back to you according to the following timeframes:

  • Routine – 10 calendar days upon receipt of request.
  • Urgent – Three business days upon receipt of request. An urgent request is appropriate for a non-life-threatening condition, which if not treated promptly, will result in a worsened or more complicated patient condition. We encourage you to call the Prior Authorization department at 1‑866‑600-2139 for all urgent requests.

Subcontractors

Aetna Better Health Premier Plan MMAI works with certain subcontractors to coordinate services that are provided by entities other than the health plan, such as transportation, vision or dental services. If you have a member who needs one or more of these services, please contact Member Services at 1‑866‑600-2139 for more information.