Prior authorization requirements
Interactive Care Reviewer (ICR) requests
To request or check the status of a prior authorization request or decision for a plan enrollee, access our Interactive Care Reviewer (ICR) tool via Availity Essentials.* Once logged in, select Patient Registration | Authorizations & Referrals, and then select Authorizations or Auth/Referral Inquiry, as appropriate.
You may also use Availity Essential’s Maternity Module to report an enrollee’s pregnancy.
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 our Preferred Drug List (PDL).
Services billed with the following revenue codes always require prior authorization:
0632 — Pharmacy multiple sources
Related information
Interested in becoming a provider in the Wellpoint District of Columbia network?
We look forward to working with you to provide quality service for our enrollees.