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Washington Providers

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.

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Prior authorization requirements

Behavioral health

Fax all requests for services that require prior authorization to:
Inpatient: 1-877-434-7578
Outpatient: 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

Pharmacy

Check our Preferred Drug List

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

0632 — Pharmacy multiple sources

Medicare/long-term services and supports

Medicare

Prior Authorization is not required for physician evaluation and management services for members of the Amerigroup Amerivantage (Medicare Advantage).

Long-term services and supports

Providers needing an authorization should call 1-877-440-3738.

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

Provider tools & resources

Interested in becoming a provider in our network?

We look forward to working with you to provide quality service for our members.