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.
- Inpatient services and non-participating providers always require prior authorization.
- This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all non-covered services (for example, experimental procedures, cosmetic surgery, etc.) — refer to your Provider Manual for coverage/limitations.
* Services may be listed as requiring prior authorization that may not be covered benefits for a particular member. Please verify benefit coverage prior to rendering services.
To determine coverage of a particular service or procedure for a specific member:
- Access eligibility and benefits information on the Availity Portal OR
- Use the Prior Authorization tool within Availity OR
Call Provider Services at:
1-800-454-3730 (Medicaid) or 1-866-805-4589 (Medicare Advantage)
To request authorizations:
- From the Availity home page, select Patient Registration from the top navigation.
- Select Auth/Referral Inquiry or Authorizations.