Prior Authorization Requirements
Prior authorization requirements are subject to periodic changes. Please use our Interactive Care Reviewer (ICR) tool via Availity to determine if a procedure code requires prior authorization before rendering services to members. Failure to do so may result in denial of reimbursement.
To use this tool, you must have an Availity account and be assigned to the ICR tool. Contact your organization’s Availity administrator if you need access.
Once logged in to Availity, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate.
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To submit prior authorizations, use Availity. Paper prior authorizations may be faxed to:
Services billed with the following revenue codes always require prior authorization:
- 0240–0249 — all-inclusive ancillary psychiatric
- 0901, 0905 to 0907, 0913, 0917 —behavioral health treatment services
- 0944 to 0945 — other therapeutic services
- 0961 — psychiatric professional fees
Prior authorization is not required for physician evaluation and management services for members of the Medicare Advantage Classic plan. For more information, visit the Healthy Blue Medicare site.
Provider Tools & Resources
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- Precertification Lookup Tool
- Prior Authorization Requirements
- Claims Overview
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- Quality of Care Incident Form