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Prior authorization (PA)
PA is required [for some out-of-network providers, outpatient care and planned hospital admissions]. We don’t require PA for emergency care. You can find a current list of the services that need PA on the Provider Portal. You can also find out if a service needs PA by using ProPAT, our online PA search tool.
Questions?
Check out your provider manual (PDF). Or call [Provider Services/Provider Relations] at [provider services phone].
Check out your provider manual (PDF). Or call [Provider Services/Provider Relations] at [provider services phone].
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Tips for requesting PA
A request for PA doesn’t guarantee payment. We can’t reimburse you for unauthorized services. You can make requesting PA easier with these tips:
- Register for Availity if you haven’t already.
- Verify member eligibility before providing services.
- Complete and send the PA request form (PDF) for all medical requests.
- Attach supporting documents when you submit the form.
How to request PA
You can request PA:
By phone
Ask for PA by calling us at [provider services phone].
By fax
Download our PA request form (PDF). Then, fax it to us at [provider services fax or PA-specific fax].
And be sure to add any supporting materials for the review.