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Prior Authorization

Prior Authorization (PA) is required for certain services. Some examples include inpatient care, partial hospitalization for substance use, care in a psychiatric residential treatment facility, and treatment by out-of-network providers. 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.


Search ProPAT



Just call:


Provider Relations: 1-833-711-0773 (TTY: 711) Monday through Friday, 7 a.m to 8 p.m.

You can also check out your provider manual (PDF).

Tips for requesting PA

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 with these tips:


  • Register for Availity if you haven’t already. 
  • Verify member eligibility before providing services.


How to request PA


Need to request PA? You can do so online using our Provider Portal.

Note: Psychiatric Residential Treatment Facility (PRTF) requests are now completed by Care Coordinators (CC) in FamilyCare Central (FCC) through the CFT process. Please contact the youth’s CC if you wish to discuss submitting a prior authorization for PRTF.

PHP Prior Authorization Form


ODM-SUD Prior Authorization Form


Non-PAR Prior Authorization Form

Medical Necessity Criteria

We use the following medical review criteria to determine medical necessity:


  • Criteria required by applicable state or federal regulatory agencies
  • Aetna Medicaid Pharmacy Guidelines
  • Milliman Care Guidelines (MCG)
  • American Society of Addiction Medicine (ASAM)
  • Aetna Clinical Policy Bulletins (CPBs)
  • Aetna Clinical Policy Council Review Unit


To request a copy of our review criteria in reference to an authorization request, you can call 1-833-711-0773 (TTY: 711), Monday through Friday from 7 a.m. to 8 p.m. 

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