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Providers

Precertification Requirements


Behavioral Health

Fax all requests for services that require precertification to:
Inpatient 1-877-434-7578
Outpatient 1-800-505-1193

Services billed with the following revenue codes ALWAYS require precertification:
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 precertification:
0632 — Pharmacy multiple sources

Medicare

Precertification is not required for physician E&M services for members of the Medicare Advantage Classic plan.

Long-Term Services and Supports

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

The following ALWAYS require precertification:
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

Precertification Tool

To request or check the status of a precertification request or decision, please login to Availity.



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Related Resources

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