Referrals & Prior Authorization

HAP Ë¿¹Ï¶ÌÊÓƵ covers all medically necessary Medicaid-covered services at no cost to you. Medically necessary means you need the services to prevent, diagnose, or treat a medical condition. Some of these services may require a referral from a provider. A referral is when a provider recommends or requests services or care from a specialist for you. Your provider will either call and arrange these services for you, give you a written approval to take with you to the referred services, or tell you what to do.

Sometimes, you may need care or a type of service that requires a prior authorization. Prior authorization is how we decide if a service will be covered by HAP Ë¿¹Ï¶ÌÊÓƵ. HAP Ë¿¹Ï¶ÌÊÓƵ must review and approve these services before you get them. For example, some procedures and most hospital stays will need prior authorization. As a member of HAP Ë¿¹Ï¶ÌÊÓƵ, you do not need to ask for the prior authorization from us. Your provider will request this approval for you.

We have a full list of services that require prior authorization for you to view. There is a 30-calendar day advance notice if there are any changes to this list. Please call Member Services if you have any questions or would like a printed copy of any of the changes to the prior authorization list.

Please Note:

  • You must get services from facilities and/or providers in the HAP Ë¿¹Ï¶ÌÊÓƵ network. Network or in-network provider refers to the providers who accept HAP Ë¿¹Ï¶ÌÊÓƵ insurance and see patients who are covered through HAP Ë¿¹Ï¶ÌÊÓƵ.
  • When you see a provider who is not in the HAP Ë¿¹Ï¶ÌÊÓƵ network, Prior Authorization is required except in emergency situations. You do not need a prior authorization for any office visit or procedure done at provider offices (PCP or specialty provider) in the HAP Ë¿¹Ï¶ÌÊÓƵ network.
  • Please check the Prior Authorization List prior to your request as changes may occur throughout the year.

Member Services: 1-833-230-2053 (TTY: 711), 24 hours a day, seven days a week.