Authorizations for in-network providers

We require prior authorization for certain services and procedures. In these cases, providers will submit clinical documentation and medical records demonstrating that the service or procedure is medically necessary.

How to request an authorization

Submit authorizations through our Authorizations Request tool. Turnaround times vary by plan requirements, but in all cases are 14 days or less.

Request an authorization Check authorization status

Exceptions

Use the forms linked below to request authorizations for the following procedures:

• Solid organ transplant prior authorization form
• Bone marrow/stem cell transplant prior authorization form
• NICU/sick newborn prior authorization form
• Inpatient PMU Medicaid medical consult request form

About our Authorization Request tool

Our Authorization Request tool has two portals – Guiding Care and eviCore. The tool will automatically select the correct portal based on your authorization type:

GuidingCare authorization types

• Post-acute facilities
• Behavioral health
• Durable medical equipment (DME)
• Inpatient
• Outpatient
• Spine surgery
• Joint surgery
• Home health care
• Planned surgeries and procedures

eviCore authorization types

• High-tech imaging
• Lab and genetic services 

Services not included in our Authorization Request tool

• Drug authorizations not related to an inpatient stay or home infusions. Use our drug authorization request forms.
• Medicare non-coverage notices
• Services not covered by our plans

Resources