Authorizations for out-of-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

Use the forms below to request prior authorization for medical services. Always use a specific service form when available. Turnaround times vary by plan requirements, but all cases are 7 days or less.

Cardiac & MSK services managed by TurningPoint

TurningPoint manages certain cardiac, MSK, joint and spine procedures and services on behalf of our members.

If requesting a procedure or service managed by TurningPoint, use the TurningPoint prior authorization form.

All other procedures / services

Provider Portal submission (preferred)

The fastest way to submit an authorization request and get a response from Priority Health is through our Provider Portal. All providers, including out-of-network providers, may create a portal account and submit / manage authorization requests there. This is the preferred method. Create a portal account today.

Fax form submission

Alternatively, out-of-network providers may use the fax forms linked below. Please select the form that most closely fits the service / procedure being requested.

Outpatient, elective/planned inpatient admissions

• Medical prior authorization form
  New form: Use this form for medical prior authorization requests. Effective Apr. 7, 2025, we'll only accept this new form. Old forms will be returned via fax as they don’t have all the necessary information. Before using this form, review the prior authorization forms below to determine whether there’s a specific service form available for your request.
• Clinical trials prior authorization form
• DME/P&O prior authorization form

Hospital and other facility

• Acute Rehab/LTACH/SNF/SAR prior authorization/review form
• Bone marrow/peripheral stem cell or other blood cell transplant prior authorization form
• Emergent inpatient prior authorization form
  A request is considered emergent if delaying treatment would put the patient’s life in serious danger, interfere with full recovery or delay treatment for severe pain. Don’t use this form for elective/planned inpatient admissions, instead use the Medical Prior Authorization Form. If we determine your request doesn’t meet the definition of an emergent authorization, it will be processed according to standard timelines. All emergent cases are reviewed in 72 hours or less.
• NICU/sick newborn prior authorization form
• Solid organ transplant prior authorization form

Behavioral health

• Applied Behavioral Health (ABA) therapy prior authorization form
• Behavioral health prior authorization form
  Use this form for psychiatric inpatient, outpatient psychotherapy (mental health and substance abuse), detoxification, residential treatment and other behavioral health services.
• Transcranial Magnetic Stimulation (TMS) for depression prior authorization form

Home health care services

• Home health care services prior authorization form
• Home health care IV infusion services prior authorization form

How to check your authorization status

1. Log into your Provider Portal account.
2. Open the Authorizations menu.
3. Click Check Auth Status.

Don't have a portal account? Contact our Provider Helpline for help checking the status of your authorization request.