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Prior authorizations

Please verify benefit coverage prior to rendering services. Inpatient services and non-participating providers always require prior authorization/precertification.

Please note:

  1. This tool is for outpatient services only.
  2. Inpatient services and non-participating providers always require prior authorization.
  3. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all non-covered services (for example, experimental procedures, cosmetic surgery, etc.). Refer to your Provider Manual for coverage/limitations.

* Services may be listed as requiring prior authorization that may not be covered benefits for a particular member. Please verify benefit coverage prior to rendering services.

To determine coverage of a particular service or procedure for a specific member:


  • Access eligibility and benefits information on the  Availity Portal*.
  • Use the Precertification Lookup Tool accessed through Payer Spaces in Availity.
  • Call Provider Services at 1-844-421-5662.

Provider tools & resources

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We look forward to working with you to provide quality service for our members.