Precertification Lookup Tool
Please verify benefit coverage prior to rendering services. Inpatient services and nonparticipating providers always require precertification.
Please note:
- This tool is for outpatient services only.
- Inpatient services and nonparticipating providers always require precertification.
- 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 precertification 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 Essentials .
- Use the precertification tool within Availity.
- Call Provider Services at 1-800-454-3730.
To request authorizations:
- From the Availity home page, select Patient Registration from the top navigation.
- Select Auth/Referral Inquiry or Authorizations.
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Precertification lookup tool
- Precertification requirements
- Claims overview
- Member eligibility & pharmacy overview
- Policies, guidelines & manuals
- Referrals
- Forms
- Training academy
- Pharmacy information
- Electronic data interchange (EDI)