Authorizations & Referrals

Fee Schedule Lookup

Use the fee schedule lookup first to determine what codes require prior authorization and who needs to authorize them.
Note: Procedures, services and supplies that have a "No" in the prior auth column do not need prior authorization for proper and necessary healthcare services when:
the claim is allowed and open on the date of service, and the service is prescribed by the attending provider (or surgeon) for an accepted condition on the correct side of the body.

Utilization Review

Find out what treatments require utilization review and what you as the provider need to do. All inpatient services, advanced imaging, physical and occupational therapy after the 24th visit, and selected outpatient services require utilization review.

Occupational Nurse Consultant Authorization

Find out what service require authorization by an occupational nurse consultant.

Services that Require Claim Manager Authorization

Find out what procedures, durable medical equipment, prosthetics, and orthotics must be authorized by the claim manager.

Retrospective Authorization

Find out how to seek Retrospective Authorization.

Provider Hotline Authorizations

Find out what procedures, durable medical equipment, prosthetics, and orthotics must be authorized by the provider hotline.

Pharmacy Authorizations

Find out what pharmaceuticals require pre-authorization.