Precertification Requirements
Medical
To request precertification for Simply Medicaid, Clear Health Alliance and Florida Healthy Kids:
• Phone: 1-844-405-4296
• Fax: 1-800-964-3627
To request precertification for Medicare Advantage:
• Phone: 1-844-405-4297
• Fax: 1-866-959-1537
Behavioral Health
To request precertification for outpatient services: Fax 1-800-370-1116
To request precertification for Inpatient, IOP, PHP, SIPP or RTC: Call Beacon Health Options using one of the phone numbers listed below.
For more information regarding precertification requests for Behavioral Health, visit Beacon Health Options or call:
Medicaid: 1-844-375-7215
Florida Healthy Kids: 1-855-861-2142
Medicare: 1-877-698-7787
For providers wanting to join Beacon’s Network, call: 1-786-837-2850
Services billed with the following revenue codes ALWAYS require precertification:
0240–0249 — All-inclusive ancillary psychiatric
0901, 0905–0907, 0913, 0917 — Behavioral health treatment services
0944–0945 — Other therapeutic services
0961 — Psychiatric professional fees
Pharmacy
Check our preferred drug list
Services billed with the following revenue codes ALWAYS require precertification:
0632 — Pharmacy multiple sources
Medicare
Precertification is not required for physician E&M services for members of the Medicare Advantage Classic plan.
Long-Term Services and Supports
Providers needing an authorization should call 1-877-440-3738.
The following ALWAYS require precertification:
Elective services provided by or arranged at nonparticipating facilities
All services billed with the following revenue codes:
0023 — Home health prospective payment system
0570–0572, 0579 — Home health aide
0944–0945 — Other therapeutic services
3101–3109 — Adult day and foster care
Precertification Tool
To request or check the status of a precertification request or decision, please login to Availity.