Prior Authorization
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Ë¿¹Ï¶ÌÊÓƵ® evaluates prior authorization requests based on medical necessity, medical appropriateness and benefit limits.
Services That Require Prior Authorization
Please refer to the to check whether a service requires prior authorization. All services that require prior authorization from Ë¿¹Ï¶ÌÊÓƵ should be authorized before the service is delivered. Ë¿¹Ï¶ÌÊÓƵ is not able to pay claims for services in which prior authorization is required, but not obtained by the provider.
Prior Authorization Submission Options
Method | Contact Info |
---|---|
(Preferred) | If you need assistance with submitting your prior authorization or have questions regarding submissions via the Provider Portal, please email CiteAutoAssistance@Ë¿¹Ï¶ÌÊÓƵ.com and a representative will be in contact. This email is only for assistance and questions regarding prior authorizations within the Provider Portal. |
Phone | 1-833-230-2176 |
Fax | Outpatient/Inpatient Elective Fax: 1-844-417-6157 |
Emergency Inpatient Admissions Fax: 1-844-417-6157 | |
SNF Fax: 1-844-417-6157 | |
Ë¿¹Ï¶ÌÊÓƵ |
Written prior authorization requests should be submitted on the Medical Prior Authorization Request Form.
Non-Participating Providers
Prior authorization must be obtained before sending patients to non-participating providers, with the following exceptions:
Service Type | Contact Information |
---|---|
Emergency Use of emergency services does not require authorization. Admissions that result from emergency room visits do require authorization. | 1-833-230-2176 |
Post-Stabilization Prior authorization is not required for coverage of post-stabilization services when these services are provided in any emergency department or for services in an observation setting by a participating provider. |
Advanced Imaging Prior Authorization
Ordering physicians must obtain prior authorization for the following outpatient, non-emergent diagnostic imaging procedures:
- MRI/MRAs
- CT/CTA scans
- PET scans
Ordering providers can obtain prior authorization from NIA for imaging procedures at RadMD’s .