Request elective retrospective authorizations through Clear Coverage™ starting Aug. 15

Effective Aug. 15, we're making it faster and easier to request elective retrospective authorizations using Clear Coverage™. 

Retro authorizations are the latest enhancement to Clear Coverage™, a tool that's already made authorizations for many procedures and services faster and easier. You can:

  • Use one process to request retro and prior authorizations for certain services 
  • Request elective retro authorizations online 24/7
  • Backdate the date of service up to one year
  • Get automatic approvals if the request meets Clear Coverage™ and InterQual (IQ) criteria
  • Get faster approvals for retro authorizations that need additional review
  • No need to communicate with Priority Health outside of the Clear Coverage™ tool

Soft launch June 15

Starting on June 15, you can start submitting retro authorizations through Clear Coverage™. Please don't duplicate requests by also faxing.

Plan types affected

Commercial and Medicaid: This new capability applies to services that can be requested today via Clear Coverage™

today for commercial and Medicaid.

Medicare: Only the following items can be requested retrospectively through Clear Coverage™.

  • DME rentals, capped or short term, such as CPAP, wheelchairs, hospital beds, etc.
  • Enteral formulas 

Medicare does not allow for retro authorizations for others services, so requests will be canceled. Your next step is the appeal process.

When to fax instead

A reminder that non-participating providers can't use Clear Coverage™. They must fax auth requests to us.

To request a retro authorization request in Clear Coverage™, the member must have active coverage with Priority Health. If a member's coverage has termed, the request must be faxed.

Rebilling process

Once the retro authorization is approved, you'll need to re-submit the claim for the services entered and approved. 

If you submit the retro authorization via fax, you'll need to first check the Provider Center > Auth Inquiry tool to see if your request was approved. Then you can submit your claim. 

The claim will need to be re-submitted as a new claim with the approved authorization number.

This rebilling process does not include Behavioral Health services.


Go to our Clear Coverage™ training resources page for a PDF of instructions with FAQs for more information.