Precertification Information

Is precertification required?
Precertification Lookup Tool

Participating providers

Behavioral Health

Fax all requests for services that require precertification to:
Inpatient 1-877-434-7578
Outpatient 1-800-505-1193

Services billed with the following revenue codes ALWAYS require precertification:

  • 0240–0249 — All-inclusive ancillary psychiatric
  • 0901, 0905–0907, 0913, 0917 — Behavioral health treatment services
  • 0944–0945 — Other therapeutic services
  • 0961 — Psychiatric professional fees

Pharmacy

Check our preferred drug list by product and state.

Services billed with the following revenue codes ALWAYS require precertification:

  • 0632 — Pharmacy multiple sources
  • Medicare/Long Term Support Services

The following ALWAYS require precertification:

  • Elective services provided by or arranged at nonparticipating facilities
  • All services billed with the following revenue codes:
    • 0023 — Home health prospective payment system
    • 0570–0572, 0579 — Home health aide
    • 0944–0945 — Other therapeutic services
    • 3101–3109 — Adult day and foster care

Nonparticipating providers

All services you render require precertification:
Fax to 1-800-964-3627
Or call 1-800-450-8753 (Medicaid)