Precertification & Claims
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)