Precertification Lookup Tool

Please note:

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

*Services may be listed that are not covered benefits, whether they do or do not require precertification. Verify benefit coverage prior to rendering services.

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

Step 1:

Access eligibility and benefits information on the  Availity Web Portal .

Step 2:

Use the Prior Authorization tool above or within Availity.

Step 3:

If the service/procedure requires preauthorization, visit the Availity Web Portal .

To request authorizations:
  1. From the Availity home page, select ‘Patient Registration’ from the top navigation.
  2. Select ‘Auth/Referral Inquiry’ or ‘Authorizations’.

Provider tools & resources

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