Authorization, eligibility and benefits are important things to know to ensure you provide the best service to your patients. We provide several options for you to get this information quickly and accurately.
Authorization
To search for authorization by code, scroll to use the Prior Authorization Lookup Tool below.
Medical Services
To request a prior authorization for medical services, you can:
- Call Provider Service at 866-757-8286.
- Use My Insurance ManagerSM.
- Use the Medical Forms Resource Center.
Behavioral Health Services
To request a prior authorization for behavioral health services, you can:
- Call 800-868-1032.
- Forms Resource Center — This online tool makes it easy for behavioral health clinicians to submit behavioral health prior authorization requests. The tool guides you through all the forms you need so you can avoid follow-up calls for additional information.
- Fax 803-870-6506.
Eligibility and Benefits
To get eligibility and benefits for a patient, you can:
- Call Provider Service at 866-757-8286.
- Use My Insurance Manager.
Prior Authorization Lookup Tool
Please verify benefit coverage prior to rendering services. Inpatient services and nonparticipating providers always require prior authorization (PA).
Please note:
- Enter one CPT code at a time into the search.
- This tool is for outpatient services only.
- Inpatient services and nonparticipating providers always require PA.
- This tool does not reflect benefits coverage nor does it include an exhaustive list of all noncovered services (that is, experimental procedures, cosmetic surgery, etc.). Refer to your provider manual for coverage/limitations.
- For specialty pharmacy codes, visit the Pharmacy page and click on the "medical specialty drug list".
- These codes are valid as of 8/1/2024.