Precertification Requirements
Behavioral Health
Fax all requests for services that require precertification to:
Inpatient 1-877-434-7578
Outpatient 1-800-505-1193
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.