Preauthorization Lookup

INTotal Health regularly reviews authorization requirements to ensure that we manage the care of our members efficiently. Effective Jan. 1, 2017, the following list reflects changes to our pre-authorization requirements. All non-emergent services rendered by non-participating providers require pre-authorization.

Depending on the program the patient is enrolled in (Medallion 3.0, FAMIS, or FAMIS MOMs), please check to ensure services are a covered benefit prior to checking pre-authorization requirements. Review Covered Services on Page 14 of the Provider Manual.

The following ALWAYS require Pre-authorization:

  • Elective services provided by or arranged at non-participating facilities
  • All non-emergent inpatient services
  • All services billed with the following revenue codes:
    • 0023 — Home health prospective payment system
    • 0240–0249 — All-inclusive ancillary psychiatric
    • 0570–0572, 0579 — Home health aide
    • 0632 — Pharmacy multiple sources
    • 0901, 0905–0907, 0913, 0917 — Behavioral health treatment services
    • 0944–0945 — Other therapeutic services
    • 0961 — Psychiatric professional fees
    • 1002 — Residential Treatment – Chemical Dependency
    • 3101–3109 — Adult day and foster care

Pre-authorization approval of services does not guarantee payment, since claims payment is subject to member and provider eligibility requirements, contractual benefits coverage and exclusions. Please note, services which require a pre-authorization for payment and are rendered without first requesting and obtaining approval of the required service may not be paid. However, all inpatient stays for emergent or urgent services (including deliveries) require notification within 24 hours or the next business day after admission. Failure to provide notification of an inpatient stay (including deliveries) may result in a payment denial.

Pre-Authorization Lookup

Search all other services

To determine if a pre-authorization or notification is required, complete the form below, then click FIND A CODE. * – Required Field

Enter either a current-year CPT/HCPCS code or code description.

Before you can get certain healthcare services, a prescription drug, tests, health care service, or durable medical equipment, you may need to get preapproval from your insurance company. This is sometimes called prior approval or precertification. Your health insurance or plan may ask you to undergo preauthorization for certain services before you receive them, except it’s an emergency. If prior approval has not been obtained for the procedure, seeking medical help is not an insured event and is not covered by insurance. Keep in mind that preauthorization does not guarantee that your health insurance or plan will cover the cost.