Some common services must be authorized by a claim manager, including:

  • Outpatient surgeries/procedures.
  • Consultations, such as;
    • Psychiatric,
    • Pain Clinics.
  • Referrals to mental health specialists.
  • Office visits by all attending provider types in excess of the first 20 visits or 60 days (whichever occurs first).
  • Home nursing, attendant services or convalescent center care must be authorized per provisions outlined in WAC 296-20-091.
  • Prescriptions drugs, see our Drug Policy page for more information.

You can enter a procedure code ID in our Fee Schedule Lookup to find out if it requires authorization by a claims manager.

How to submit an authorization request

  • Complete the preauthorization form (F242-397-000), and fax it to 360-902-4567. Requests are usually responded to within 2-5 business days.
  • For urgent requests that need to be authorized within two days, call your claim manager.
    • Be sure to identify the procedure code(s), dates of service, diagnosis, prescribing provider and your contact information when requesting authorization.

Note: For utilization review (UR), or Comagine (e.g., inpatient surgery/MRIs) see Utilization Review.

Don't know who the claim manager is?

  • You can call the Automated Claim Information Line (800-831-5227) to obtain the name and phone number of the claim manager on a particular claim.
  • Call 360-902-6767 and your call will be forwarded to the appropriate claim manager.

Note: If you are the attending provider you can also check the Claim and Account Center, to see if treatment has been authorized on a claim.