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Prior authorization

Prior authorization is required for certain Medicaid services and supplies, like home-based care or durable medical equipment (DME). 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

 

Questions?

Check out your provider manual (PDF). Or call Provider Relations at 1-888-348-2922 (TTY: 711).

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.
  • Based on the type of request, complete and submit either the physical health PA form (PDF) or the behavioral health PA form (PDF).
  • Attach supporting documents when you submit the form. Examples of supporting documents include:
    • Current visit notes describing member condition
    • Reason services are being requested

Learn more about utilization management (UM)

How to request PA

 

You can request PA:

Online

Ask for PA through our Provider Portal.

By phone

Ask for PA by calling us at 1-888-348-2922 (TTY: 711).

By fax

Download our PA request form (PDF). Then, fax it to us at 1-866-366-7008.

 

And be sure to add any supporting materials for the review.