Precertification requirements
To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. Once logged in, select Patient Registration | Authorizations & Referrals, and then choose Authorizations or Auth/Referral Inquiry, as appropriate.
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Behavioral health
Please submit all precertification requests through our preferred method at Availity.com
If you prefer to paper fax, please submit correct forms to:
Inpatient:
Outpatient:
Services billed with the following revenue codes always require precertification:
| 0240 to 0249 | all-inclusive ancillary psychiatric |
| 0901, 0905 to 0907, 0913, 0917 | behavioral health treatment services |
| 0944 to 0945 | other therapeutic services |
| 0961 | psychiatric professional fees |
Pharmacy
Check our Preferred Drug List .
Services billed with the following revenue code always require precertification:
| 0632 | pharmacy multiple sources |
Medicare/ Long-Term Services and Supports (LTSS) program
Medicare
Precertification is not required for physician evaluation and management services for members of the Medicare Advantage Classic plan.
Long-Term Services and Supports (LTSS) program
Providers needing an authorization should email us at ltcprovreq@wellpoint.com or call 1-866-840-4991.
Call:
The following always require precertification:
- Elective services provided by or arranged at nonparticipating facilities
- All services billed with the following revenue codes:
| 0023 | home health prospective payment system |
| 0570 to 0572, 0579 | home health aide |
| 0944 to 0945 | other therapeutic services |
| 3101 to 3109 | adult day and foster care |
Email:
Related information
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub
- Learn about Availity
- Precertification lookup tool
- Precertification requirements
- Claims overview
- Member eligibility & pharmacy overview
- Policies, guidelines & manuals
- Referrals
- Forms
- Training academy
- Pharmacy information
- Electronic data interchange (EDI)
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