Precertification Information

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)