Autorización previa

Prior authorization (PA) is required for acute outpatient services and planned hospital admissions. We don’t require PA for emergency care. You can 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 Experience at 1-855-221-5656 (TTY: 711).

Tips for requesting prior authorization

Tips for requesting prior authorization

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 Provider Portal if you haven’t already.
Verify member eligibility before providing services.
Complete and send the PA request form. Choose from these forms based on the type of request:
- Physical health standard PA request form
- Behavioral health PA request form
Include any supporting materials (clinicals, labs, CGM recordings, etc.) and fax them to: 1-855-225-4102. Nota: All supporting materials must be submitted by fax regardless of the type of PA request.

How to request prior authorization

You can request PA:

Online

Ask for PA through our Provider Portal.

Visit the Provider Portal

By phone

For urgent PA requests, you can call us at 1-855-221-5656 (TTY: 711).

By fax

Download and complete one of our PA request fax forms. Then, fax it to us at 1-855-225-4102.

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