Prior Authorization Requests
Utilization Management Team Extends Dates of Service for Approved Prior Authorization Requests
To comply with the Office of the Superintendent of Insurance’s request to minimize prior authorization requirements for COVID-19 testing and treatment, our Utilization Management (UM) team has extended the dates of service for a prior authorization request approved for a service that was delayed or cancelled due to COVID-19.
- Providers can fax an extension request to the UM team at 1-866-446-3774 or call 1-844-508-4677 to request the extension.
- Providers don’t need to resubmit all the clinical information for an already approved authorization.
How to Obtain Clinical Criteria for Prior Authorization
Providers do not need to submit a prior authorization request, or receive an approval or denial, to obtain clinical review criteria for prior authorization. To obtain clinical criteria for prior authorization, please call 1-844-508-4677.
Which Services Require Prior Authorization?
Begin a Prior Authorization Request for Services Covered under the Medical Benefit
You may begin prior authorization requests via the Provider Portal or via fax.
- Download and complete the Prior Authorization Request Form and fax it to 1-866-446-3774.
Please note: Medical prior authorizations for federal employees (FEHB members) can be submitted only via fax. Please see #2 above for prior authorization fax instructions.
Urgent and After-Hours Prior Authorization Requests
- To submit an urgent after-hours prior authorization request, please call our Customer Care Center at 1-844-508-4677 and follow the prompts to reach the after-hours prior authorization nurse.
- After-hours requests must be submitted verbally and be urgent in nature. We will process routine prior authorization requests during regular business hours.
Begin a Prior Authorization Request for Services Covered under the Pharmacy Benefit
Need Help Submitting Prior Authorizations via Our Provider Portals?
- Contact the Application Support Team by email at firstname.lastname@example.org or by phone at 1-888-959-4031.
- Identifi Health Plan enhancement: Users now can view authorization requests where the National Provider Identifiers (NPIs) they have access to are listed as the Rendering or Attending provider in addition to Requesting. For details, please view this slide deck.