Prior Authorizations

There are several factors that impact whether a service or procedure is covered under a member’s benefit plan. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. These documents are available to you as a reference when interpreting claim decisions.

Prior Authorization Code Lists

Use these lists to identify the member services that require prior authorization.

Digital Authorizations

Submit for medical or behavioral health inpatient or outpatient services. Tract authorization cases. Access the Authorization application from the Patient Registration tab in Availity Essentials.

Availity.com