Precertification lookup tool
Please verify benefit coverage prior to rendering services. Inpatient services and nonparticipating providers always require prior authorization.
Please note:
- This tool is for outpatient services only.
- Inpatient services and nonparticipating providers always require prior authorization.
- This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all noncovered 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 Precertification tool within Availity or
Call Provider Services at:
Medicaid/CHIP:
Medicare Advantage:
Wellpoint STAR+PLUS MMP Medicare-Medicaid Plan:
To request authorizations:
- From the Availity home page, select Patient Registration from the top navigation
- Select Auth/Referral Inquiry or Authorizations & Referrals
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub
- Learn about Availity
- Precertification Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Member Eligibility & Pharmacy Overview
- Provider Manuals and Guides
- Referrals
- Forms
- Training Academy
- Pharmacy Information
- Electronic Data Interchange (EDI)
Interested in becoming a provider in the Wellpoint network?
We look forward to working with you to provide quality services to our members.
Join our network