Submit a Prior Authorization

FOR MEDICAL PROFESSIONAL USE ONLY

Prior Authorization Instructions

Prior authorization (PA) is required before certain services are rendered to confirm medical necessity. No PA is required for emergency or transportation services. All services for out-of-network providers, except emergency services, require prior authorization. Criteria utilized in decision making can be accessed through the secure provider portalExternal Link.

How to Request a Prior Authorization

Vendor SolutionsVendor Links
DentalEnvolve DentalExternal Link
MRA, MRI, PET, CT Scans, and Cardiac ImagingEvolentExternal Link
Pain ManagementEvolentExternal Link
Speech, Occupational and Physical TherapyEvolentExternal Link
Musculoskeletal ServicesEvolentExternal Link
Non-Emergent Non-Ambulance TransportationMTMExternal Link
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