Prior Authorization requirements

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

Don’t have an Availity account?

Need help with Availity?

Learn more

Behavioral health

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

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

0632	Pharmacy multiple sources

Medicare or long-term services and supports

Medicare

Precertification is not required for physician Evaluation and Management services for members enrolled in the Amerivantage Balance (HMO) plan.

Long-term services and supports

All services require precertification:

Personal care assistants: Call 1-732-452-6050 and select option 1 or fax requests to 1-888-240-4716
Adult medical day care: Fax all requests to 1-888-240-4717