Prior authorization requirements
Determine how to submit authorization requests and what services require prior authorization.
Submit prior authorization requests
Wellpoint providers will not be able to submit prior authorization requests through Availity. That feature is not turned on. The best way for providers to submit these requests is by faxing the request to the new Wellpoint UM fax line: (866)-988-2812, which will be in place on 3/1/26.
Interactive Care Reviewer (ICR) tool
Providers can use the Interactive Care Reviewer (ICR) tool to make inquiries on previously submitted requests, regardless of how they were sent (phone, fax, etc.).
To check the status of a prior authorization request or decision for a particular plan member, access our ICR tool via Availity. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate.
Long-term services and supports (LTSS) revenue codes
Services billed with the following revenue codes always require prior authorization:
0023 — Home health prospective payment system
0570–0572, 0579 — Home health aide
0944–0945 — Other therapeutic services
3101–3109 — Adult day and foster care
Prior authorization contact information
Providers and staff can also contact Wellpoint for help with prior authorization via:
Wellpoint Provider Services
Phone: 1-929-946-5900
Hours: Monday to Friday 9:00 a.m. to 5:00 p.m.
Fax: 1-866-661-2145
Need more assistance with authorization?
For more information surrounding authorization requests, please refer to your provider manual for assistance.
Interested in becoming a provider in the Wellpoint network?
We look forward to working with you to provide quality service for our members.