Authorization

Fee Schedule Lookup
Use this site first to determine what codes require prior authorization and who needs to authorize them.
Note: Procedures, services and supplies that have a "No" in the prior auth column do not need prior authorization for proper and necessary healthcare services when:

  • the claim is allowed and open on the date of service, and
  • the service is prescribed by the attending provider (or surgeon) for an accepted condition on the correct side of the body.

Claim Manager Authorizations
Find out what procedures, durable medical equipment, prosthetics, and orthotics must be authorized by the claim manager.

Utilization Review
Find out what treatments require utilization review and what you as the provider need to do.

  • All inpatient services, advanced imaging, physical and occupational therapy after the 24th visit, and selected outpatient services require utilization review.

Provider Hotline Authorizations
Find out what procedures, durable medical equipment, prosthetics, and orthotics must be authorized by the provider hotline.

Pharmacy Authorizations
Find out what pharmaceuticals require pre-authorization.

Occupational Nurse Consultant Authorizations
Find out what service require authorization by an occupational nurse consultant.

Retrospective Authorization
Find out how to seek Restrospective Authorization.

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