Prior authorization
Prior authorizations (also referred to as pre-approvals, pre-authorizations, and pre-certifications) can be submitted digitally using the authorization application in Availity Essentials.
Prior authorization code lists
Use these lists to identify the member services that require prior authorization.
Digital authorizations
Submit for medical or behavioral health inpatient or outpatient services. Track authorization cases. Access the authorization application from the Patient Registration tab in Availity Essentials.
Preauthorization exemptions
Under Texas HB3459, if you qualify for Preauthorization (PA) Exemption Status as a care provider in Texas, you may be exempt from payer-imposed prior authorization requests. Please refer to our Texas Prior Authorization List for a list of healthcare services that may require prior authorization.
To determine the initial length of stay or initial units for services with a prior authorization exemption, please refer to our Clinical Standards. Any days or units beyond what is outlined will require submission of an extension request and may be subject to medically necessary review.
Note: The preauthorization exemptions only refer to Wellpoint ACA Marketplace Individual Plans that are fully insured. Eligible members will have “TDI” or “DOI” on their ID cards.
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