Some common services must be authorized by a claim manager, including:
- Outpatient surgeries/procedures.
- Consultations, such as;
- Pain Clinics.
- Referrals to mental health specialists.
- Chiropractic visits with physicians who use E/M office visit codes.
- 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.