Precertification Lookup Tool
Please note:
- This tool is for outpatient services only.
- Inpatient services and non-participating providers always require precertification.
- 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.
Members enrolled in long-term care (LTC) require their approved services to be precertified. The assigned case manager will request approval for LTC services. Call 877-440-3738 (TTY 711) and ask for the case management team.
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:
- From the Availity home page, select ‘Patient Registration’ from the top navigation.
- Select ‘Auth/Referral Inquiry’ or ‘Authorizations’.