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Providers

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


Beacon Phone Numbers for Members and Providers:
  • 1-844-375-7215: Medicaid 
  • 1-855-861-2142: Florida Healthy Kids
  • 1-877-698-7787: Medicare
  • 1-786-837-2850 :Providers wanting to join Beacon Network
 
Preauthorizations:  
  • 1-800-221-5487: IP, IOP, PHP, SIPP, RTC  
  • 1-844-375-7215: OP Medicaid
  • 1-855-861-2142: FHK
 
Beacon Fax Numbers:
  • IP, IOP, PHP, SIPP, RTC Preauthorization:  We do not accept faxes for this LOC, only phone calls.    
  • 1-800-370-1116: Medicare Preauthorization
  • 1-800-370-1116: Medicaid Outpatient Preauthorization
 
Join Network for Providers
  • 1-786-837-2850
 
Crisis Calls for Members
  • 1-844-375-7215, Press 9, Press 1 for English or 2 for Spanish, Press 9 for Emergency, will then be transferred to a clinician

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.


 

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Related Resources

 

Provider tools & resources

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