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.
1-877-434-7578
1-800-505-1193
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 |
Services billed with the following revenue codes always require prior authorization:
0632 | Pharmacy multiple sources |
Precertification is not required for physician Evaluation and Management services for members enrolled in the Amerivantage Balance (HMO) plan.
All services require precertification:
1-732-452-6050
1-888-240-4717
The following always require prior authorization:
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 |