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District of Columbia

Prior authorization requirements


To request or check the status of a prior authorization request or decision for a plan enrollee, access our Interactive Care Reviewer (ICR) tool via Availity Essentials.* Once logged in, select Patient Registration | Authorizations & Referrals, and then select Authorizations or Auth/Referral Inquiry, as appropriate.

You may also use Availity Essential’s Maternity Module to report an enrollee’s pregnancy.

Don’t have an Availity Essentials account?

Need help with Availity Essentials?

Services billed with the following revenue codes always require prior authorization:

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 (PDL)

Services billed with the following revenue codes always require prior authorization:

0632 — Pharmacy multiple sources

Related information

Provider tools & resources

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