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Authorizations

Authorizations
Find specialty resources
Locate the right specialty service for your patients in our network. Call our Specialty Provider Locator Line to talk to a trained nurse.

Auth Status Online
Look up the status of your authorization requests online, even print them out. On the Provider Center home page, click "Authorizations", then "Auth Inquiry."

An authorization is a process in which the patient's health plan approves a service for the patient before it can be performed and then reimbursed. You must request authorization from Priority Health for some services, equipment and medications. This section lists Priority Health's authorization guidelines and practices.

Authorizations reference list
A list of services and referrals showing which plans require PA, with links to applicable forms and medical policies

Behavioral health
Getting authorization for Behavioral Heath services

Centers of Excellence
Information about our Spine, Weight Loss and Transplant Centers of Excellence and how to refer patients for treatment

Durable medical equipment (DME)
When durable medical equipment needs authorization, and how to request it

Drugs
Some drugs require prior authorization, including all injectable drugs

Radiology
How to get an RQI number for high-level diagnostic radiology services

Medical Policies
Policies that govern authorization for services

Patients without authorizations?
Here's what to do

Criteria for determining medical necessity
The Priority Health guidelines and processes to determine authorizations
Last modified 05/20/08