Prior authorization lookup tool

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

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 Essentials   OR
  • Use the Prior Authorization tool within Availity OR

Call Provider Services at:

1-833-731-2149 (Medicaid/CHIP) or 1-866-805-4589 (Medicare Advantage)

To request authorizations:

  • From the Availity home page, select Patient Registration from the top navigation
  • Select Auth/Referral Inquiry or Authorizations

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