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Prior Authorization Process Tool

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

All services performed in a hospital setting (both inpatient and hospital outpatient centers and facilities), as well as services performed in hospital-owned sites such as provider offices and imaging centers, as examples, 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 in our Preferred Specialist Network or an HCP Primary Care Physician, your patient’s medical coverage, and the services rendered.

Start by determining the Providers status.

Preferred Specialist Network (PSN) Specialist

Specialist Not in Preferred Specialty Network (PSN)

HCP Primary Care Provider

Do not know if Specialist Provider is in Preferred Specialty Network (PSN)