Online Prior Authorization (PA)

You can use our lookup tool below to find the drug you’re looking for, whether that drug requires prior authorization (PA), and the corresponding pharmacy benefit manager (PBM) or medical benefit manager (MBM) contact information. See below for how to look up medical services that require prior authorization.

Search for Drugs That Require PA

Additional Resources

Need to find out if UHA requires prior authorization (PA) for a medical service? Use this search tool to look up medical services by CPT code, CPT code description, or prior authorization type. Please note that this list includes only CPT/HCPCS codes and that any prior authorization requirements apply to all UHA medical plans. 

1. Outpatient services rendered in an inpatient setting require prior authorization.
2. For members living in Hawaii, ALL out-of-state requests require prior authorization.
3. For members on the mainland, ALL ASC or hospital-based elective procedures require prior authorization.
4. UHA reserves the right to perform retrospective review for services that do not require prior authorization to validate if services rendered met payment determination criteria.

If you already submit your claims electronically, you can also submit your prior authorization (PA) requests electronically and receive your prior authorization response via our Online Prior Authorization 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.

View our list of Services That Require Prior Authorization.

Medical Payment Policy Updates