Provider Central

Before performing a service that requires an authorization, you should take these steps:

Step	Use an eTool like Authorization Manager or ConnectCenter to determine whether a referral or authorization is required for a specific service. Learn about our eTools. Once you’ve checked member benefits and eligibility, our Inpatient Only List can help you in making level of care determinations. Please also refer to our medical policies.  Inpatient Only List January 2023 (commercial members)
Step	Submit your authorization request (see submission tips below).
Step	Check the status of your authorization request. Use Authorization Manager For instructions, download our User Guide. Receive notifications by fax by enrolling in our Automatic Fax-Back Program. This program is our automated fax process for faxing individual decision letters to enrolled providers. Once enrolled, you will receive a fax notification each time a member’s case is approved or denied in our system. To enroll in this program, please complete and return our Automatic Fax-Back Program: Request Form.
Step	Perform the service and submit the claim (after you’ve confirmed you have an authorization on file for the service).

Either the PCP or the designated specialist (with an open referral from the PCP, as applicable depending on the plan) can request authorization for outpatient services. If we have not provided approval for outpatient services that require authorization, the provider rendering the service is financially liable, unless the member has previously consented in writing to be billed.

You can initiate an authorization using:

Home health services and short-term rehabilitation
When our guidelines are followed, we automatically approve initial authorization requests for these services for our managed care members. (For our guidelines, refer to our Outpatient Rehabilitation Therapy and Home Health Care pages.)

Authorization requests for services that are automatically approved should be submitted prior to the date of service. In those cases when the PCP or designated specialist cannot enter the authorization in advance of the service, it can be submitted up to 90 days after the date of service. The extended submission window is for those rare occasions.

Submit all retroactive auto-approved authorizations via an electronic technology. Enter the actual date of service as the start date.

Note: There may be exceptions to this policy listed in your Provider Agreements.

We urge you to check on the status of your authorization requests electronically. If you have questions once you’ve taken this step, you may reach us at the phone and fax numbers indicated below.

Phone information

Fax information