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Questions?
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
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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 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.
ODM-SUD 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.