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.

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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

Prior authorization lookup tool 

Prior authorization forms