A medical assistant sits at a computer while filling out a form

Easily determine if a prior authorization is required with our search tool. Search by Current Procedural Terminology (CPT) codes, procedures or generic drug name(s). Remember to verify benefit coverage in  Availity Essentials ™.

Please reference:

  • This tool is for outpatient services only.
  • Inpatient services and nonparticipating providers always require prior authorization.
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Check Prior Authorization Requirements

Based on patient's plan

How to submit requests

Save time by reviewing what to include in your prior authorization.

What to include in a prior authorization

Basic information

  • Physician and facility information, including Tax Identification Number and National Provider Identifier (NPI) of requesting provider and servicing provider
  • Patient name, date of birth and member ID
  • Date of service
  • Contact information for person who can provide clinicals and answer questions

Letter of medical necessity

  • Summary statement of medical need and reason for request

Summary of patient’s diagnosis

  • Date of diagnosis, diagnostic and imaging results
  • Current severity of patient’s conditions
  • Any previously attempted treatments or patient intolerance to these treatments

Summary of patient’s history

  • Previously administered treatments, procedures and dates
  • Response to these treatments
  • Recent symptoms and conditions
  • Physician opinion of patient prognosis and disease progression

Medical

Determine coverage and start the prior authorization process in Availity. Or view fax forms

Pharmacy

Submit and track prior authorizations with CoverMyMeds. Or view fax forms .

For specific vendors, view our Making It Easier tip sheet

View the tip sheet

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