Pre-Authorization Requirements

Except in the case of an emergency, certain services and items must be prior authorized even if the member is seeking coverage from a non-participating health care provider. Click here for the current list effective December 1, 2009. These services include, but are not limited to:

• Inpatient admission to a non-participating facility
• All inpatient and outpatient mental health and chemical dependency services
• Home health services
• Durable medical equipment
• Corrective appliances
• Some prescription drugs. Click here for more information.
• Skin lesions. Click here for more information.
• Synagis. Click here for more information.

An Authorization Request and Notification must be used for all fax requests. This includes joint replacement surgeries, MRIs, and CT scans. Worksheets will not be accepted.