Prior authorization lookup tool
Please verify benefit coverage prior to rendering services. Inpatient services and nonparticipating providers always require prior authorization.
Please note:
- This tool is for outpatient services only.
- Inpatient services and non-participating providers always require prior authorization.
- This tool does not reflect benefits coverage,* nor does it include an exhaustive listing of all noncovered services (for example, experimental procedures, cosmetic surgery, etc.)— refer to your provider manual for coverage/limitations.
*Please note that while some services do not require prior authorization, additional actions may be required for authorization.
To determine coverage of a particular service or procedure for a specific member:
- Access eligibility and benefits information on the Availity Web Portal
- Use the Prior Authorization tool within Availity
- Call Provider Services at 1-833-731-2274
To request authorizations:
- From the Availity home page, select Patient Registration from the top navigation
- Select Auth/Referral Inquiry or Authorizations & Referrals
Provider tools and resources
- Log in to Availity Essentials
- Launch provider learning hub
- Learn about Availity Essentials
- Prior authorization lookup tool
- Prior authorization requirements
- Claims overview
- Member eligibility and pharmacy overview
- Provider manuals and guides
- Referrals
- Forms
- Training academy
- Pharmacy information
- Electronic data interchange
Interested in becoming a provider in our network?
We look forward to working with you to provide quality service for our members.
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