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District of Columbia

Prior authorization lookup tool


Please verify benefit coverage prior to rendering services. Inpatient services and non-participating providers always require prior authorization.

Please note:

  • This tool is for outpatient services only
  • This tool does not reflect benefits coverage*, nor does it include an exhaustive listing of all non-covered services (i.e., experimental procedures, cosmetic surgery, etc.). Refer to your provider manual for coverage or limitations.

*Services listed as requiring prior authorization may not be covered benefits for a particular enrollee. Please verify benefits before rendering services.

To verify enrollee eligibility or benefits:

  • Log in to the Availity Essentials portal , or
  • Use the Prior Authorization tool within Availity Essentials, or
  • Call Provider Services at 1-800-454-3730

To submit a prior authorization request:

  1. Log in to Availity Essentials .
  2. Select Patient Registration from the top navigation.
  3. Then, select Auth/Referral Inquiry or Authorizations.

Provider tools & resources

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