To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. Once logged in, select Patient Registration | Authorizations & Referrals, and then choose Authorizations or Auth/Referral Inquiry as appropriate.
Services billed with the following revenue codes always require prior authorization:
| 0240 to 0249 | all-inclusive ancillary psychiatric |
| 0901, 0905 to 0907, 0913, 0917 | behavioral health treatment services |
| 0944 to 0945 | other therapeutic services |
| 0961 | psychiatric professional fees |
Services billed with the following revenue codes always require prior authorization:
| 0632 | pharmacy multiple sources |
Prior authorization is not required for physician evaluation and management services for members enrolled in the Medicare Advantage Balance (HMO) plan.
All services billed with the following revenue codes require prior authorization:
| 0023 | Home health prospective payment system |
| 0570-0572, 0579 | Home health aide |
| 0944-0945 | 0ther therapeutic services |
| 3101-3109 | Adult day and foster care |
All long-term services and supports require prior authorization. Please use the following contact information to submit your requests.
Phone:
1-732-452-6050 (select option 1)
Fax a request:
1-888-240-4716
Fax a request:
1-888-240-4717
Elective services provided by or arranged at nonparticipating facilities always require prior authorization.
We look forward to working with you to provide quality services to our members.