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.
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
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