Prior authorization
Providers need prior authorization (PA) for some outpatient care and planned hospital admissions. We don’t require PA for emergency care. You can find a current list of the services that need PA on the Provider Portal. You can also find out if a service needs PA by using ProPAT, our online prior authorization search tool.
Need more info?
Check out your provider manual. Or call Provider Relations at 1-855-242-0802 (TTY: 711).
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Tips for requesting PA
A request for PA doesn’t guarantee payment. We can’t reimburse you for unauthorized services. You can make requesting PA easier by:
- Registering for the Provider Portal if you haven’t already
- Verifying member eligibility before providing services
- Completing the PA request form (PDF) for all medical requests
- Attaching supporting documents when you submit the form
- Review the listed services and codes requiring a prior authorization (PDF)
- Complete the CPST/PSR form (PDF) for CPST/PSR service requests
- Complete the BH Prior Auth Request form (PDF) for behavioral health requests
How to request PA
Here are the ways you can request PA:
By phone
Ask for PA by calling us at 1-855-242-0802 (TTY: 711).
By fax
Download our PA request form (PDF). Then, fax it to us at one of these numbers:
- Physical health: 1-844-227-9205
- Behavioral health: 1-844-634-1109
And be sure to add any supporting materials for the review.