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
Please reference:
- This tool is for outpatient services only.
- Inpatient services and nonparticipating providers always require prior authorization.
Check Prior Authorization Requirements
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
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
To create an account: Complete an
To start a request:
1. Sign in and go to “Patient Registration.”
2. Select “Authorizations and Referrals” and then “Authorizations.”
3. Select a request type to start your request.
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Pharmacy
To create an account: Visit
To start a request:
1. Go to “New Request,” then enter the patient’s state, medication and insurance information.
2. Select the appropriate request. Complete all “Required” fields and “Send to Plan.”
3. The request will automatically be delivered to the plan or pharmacy benefit manager (PBM) for next steps.
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