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Prior authorization

Prior authorization (PA) is required for some in-network care and all out-of-network care. 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 prior authorization search tool.

 

Search ProPAT

 

Questions?

Check out your provider manual. Or just contact us.

Check out your provider manual. Or just contact us.

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:

 

How to request PA

  • Online

     

    Ask for PA through our Provider Portal.

     

    Visit the Provider Portal

     

    By phone

     

    Ask for PA by calling us at 1-866-874-2567 (TTY: 711). 

     

    By fax

     

    Download our Medicaid PA request form (PDF). Then, fax it to us at 866-603-5535 

     

    And be sure to add any supporting materials for the review. 

     

    Requesting Peer to Peer Consultation for an existing Authorization

     

    Peer to peers are scheduled by calling 1-855-711-3801 ext. 1. within the timeframe outlined in the denial notification. Peer-to-peer consultations occur between the treating practitioner and an Aetna Better Health medical director. Peer-to-peer consultations occurs timely in a accordance with the member's clinical need. Someone other than the treating practitioner can call to schedule the peer-to-peer consultation at the request of the treating practitioner. Peer to peers are not performed in the case of a retrospective review, in these instances the appeals process is to be followed.

     

     

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