Prior Authorization Information

Participating Providers

Behavioral Health

Fax all requests for services that require prior authorization to:
Inpatient: 1-877-434-7578
Outpatient: 1-866-877-5229

Services billed with the following revenue codes always require prior authorization:

  • 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 the Preferred Drug List for Healthy Blue or visit the Formulary page to use our searchable formulary tool.

Services billed with the following revenue codes always require prior authorization:

  • 0632 — pharmacy multiple sources

The following always require prior authorization:

  • 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
  • Pharmacy prescription drug prior authorization fax: 1-844-864-7865
  • Pharmacy medical injectable prior authorization fax: 1-844-487-9291

Nonparticipating providers

All services you render require prior authorization:

  • Phone: 1-844-521-6942
Obtain Prior Authorization from our Vendors

Hi-tech radiology, cardiology and sleep medicine

AIM Specialty Health®: 1-800-714-0040

Lab services and diagnostic testing

LabCorp: 1-800-345-4363
Quest Diagnostics: 1-866-MY-QUEST (1-866-697-8378)

Nonemergency transportation

Southeastrans: 1-877-892-3988

Vision services

Superior Vision: 1-866-819-4298

Short-term rehabilitation therapy: speech, physical and occupational

OrthoNet: 1-844-511-2873

Spinal surgery

OrthoNet: 1-844-677-2610