Prior Authorization Requirements
To request or check the status of a prior authorization request or decision for a Healthy Blue member, access our Interactive Care Reviewer (ICR) tool via Availity.*
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.