Before you start searching our prior authorization tool, there are a few things you should know.
What To Know Before Searching
Search using the full procedure name.
If you don't use the full medical name of the service you're searching for, you might not find your results.
Only services needing prior authorization are shown.
If a service doesn't require prior authorization, it won't show in results. Please check that you've spelled the procedure or service correctly and by its full medical name.
Some of the information is for your provider.
Some of the information included in search results, like procedure code, is to help your provider submit the prior authorization request.
Reading the Results
If your procedure needs prior authorization, you'll find it in your search results.
Each result shows in a table that includes the:
- Procedure name: the medical name of your procedure
- Procedure code: used by your provider to file a prior authorization
- Description: describes what the procedure is and what body parts are affected
- Managed by: who processes and decides the prior authorization claims
- Updates: notes, typically effective dates, about the prior authorization requirements
Here's an example of what a result when searching "radiology" could look like.