Prior Authorization for Prescription Drugs
You can use our drug PA lookup tool below to find the drug you’re looking for, and the corresponding PBM or MBM contact information.
Prior Authorization for Medical Services
If you already submit your claims electronically, you can also submit your PA’s electronically and receive your PA response via our Online PA portal. Don’t have an account? Get one here.
Services that are medically necessary and a covered benefit under the eligible member’s health plan are usually paid automatically, but certain services require prior authorization before they can be provided. These services, especially those that may result in expensive procedures, undergo the prior authorization process to ensure those services will be covered.
We will decide within 15 days of receipt of your request for prior authorization. Read more about “medical necessity,” and details about services which require prior authorization in our Provider Handbook. Health Care Services is available to assist you with all prior authorization requests and advance notification requirements.