Precertification/ Notification Requirements

Participating providers

  • Behavioral Health

  • Fax all requests for services that require precertification to:
    Inpatient 1-877-434-7578
    Outpatient1-800-505-1193

  • The following markets may fax Behavioral Health Outpatient Requests to the specified fax line below to meet turnaround time (TAT) requirements: Iowa and Texas.
    Outpatient 1-866-877-5229

  • Services billed with the following revenue codes ALWAYS require precertification:

  • 0240–0249 — All-inclusive ancillary psychiatric
  • 0901, 0905–0907, 0913, 0917 — Behavioral health treatment services
  • 0944–0945 — Other therapeutic services
  • 0961 — Psychiatric professional fees
  • Pharmacy

    Check our preferred drug list by product and state

  • Services billed with the following revenue codes ALWAYS require precertification:

  • 0632 — Pharmacy multiple sources
  • The following ALWAYS require precertification:

    • Elective services provided by or arranged at nonparticipating facilities

    All services billed with the following revenue codes:

    • 0023 — Home health prospective payment system
    • 0570–0572, 0579 — Home health aide
    • 0944–0945 — Other therapeutic services
    • 3101–3109 — Adult day and foster care