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Prior authorization lookup tool

Please verify benefit coverage prior to rendering services. Inpatient services and nonparticipating providers always require prior authorization.

Please note:

  1. This tool is for outpatient services only.
  2. Inpatient services and non-participating providers always require prior authorization.
  3. 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.

*Please note that while some services do not require precertification, additional actions may be required for authorization.

To determine coverage of a particular service or procedure for a specific member:

  • Access eligibility and benefits information on the  Availity Web Portal
  • Use the Prior Authorization 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 & Referrals.

Provider tools & resources

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