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Prior Authorization Process Tool

Most office-based services and many freestanding Ambulatory Surgery Center (ASC) services provided by PCPs and Preferred Specialists are covered without Prior Authorization required.

All services performed in a hospital setting (both inpatient and outpatient centers and facilities) and services performed in hospital-owned sites such as provider offices and imaging centers, for example, require Prior Authorization.

Use our Prior Authorization Process Tool and quickly determine if a Prior Authorization is required for the services provided to your patient.

You will need to know if the provider is a Preferred Specialist or an HCP Primary Care Physician, your patient’s medical coverage, and the services rendered.

Start by determining the provider’s status.

Preferred Specialist Physician

Non-HCP Preferred Specialist

HCP Primary Care Provider

Do not know if Specialist Provider is a Preferred Specialist