Prior authorization lookup tool

Please verify benefit coverage prior to rendering services. Inpatient services and non-participating 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 non-covered services (in other words, 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 Availity Essentials* or

 

 Use the Prior Authorization within Availity or

 

 Call Provider Services at: 844-912-1226

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