Precertification
Fax: 1-800-964-3627
Call: 1-855-661-2028
Nonparticipating providers
All services a nonparticipating
provider renders require
precertification
Participating Providers
Precertification Lookup Tool
This tool:
- is for outpatient services-inpatient services always require precertification
- does not show benefits coverage–refer to our state-specific provider manuals for coverage/limitations
- Please note: Drug description search is case sensitive. You must search using generic/chemical ingredient name and use lower case only.
- CPT/HCPCS codes returned as requiring precertification in the Precert Look-up Tool are current and effective at the time of the search/inquiry. Any codes removed from Precert Look-up Tool since the last update do not require prior authorization. Codes requiring prior authorization may still require medical review prior to claims payment.
Please note: Benefits coverage not shown — refer to our state-specific provider manual for coverage/limitations.
Forms and Other Resources
- Associates Performing Utilization Reviews
- Emergency Services
- Prohibiting the Use of Financial Incentives
- Transplant Approval Policy
- Utilization Management- Medicaid Delegation and Oversight
- Utilization Management- Clinicians Responsibilities
- Prior Authorization Request Form
- Changes to approval notification process
- Changes to Chiropractic Services
- BH Treatment Plan Reminder
- Chiropractic Services Update
- Buprenorphine Products Prior Authorization Form Update
- Update to radiology benefit management
- Changes to precertification
- Changes to precertification
- Clinical Criteria for Utilization Management Decisions Core Process
- Concurrent Review (Telephonic and On-site) and On-site Review Protocol Process - Core Process
- Health Care Management Denial Core Process
- Clinical Information for Utilization Management Reviews Core Process
- Member Appeals and Provider Medical Necessity Administrative Denial Appeals
- Pre-certification Committee
- Pre-certification of Requested Services Core Proces
- Retrospective Review
- Subcontract UM Delegation
- Use of Board Certified Consultants Medical Behavioral Health
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