Prior authorization requirements
The preferred method to request or check the status of a prior authorization request or decision for a particular plan member is to access our Interactive Care Reviewer (ICR) tool via Availity. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate.
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Precertification requests and inpatient notification fax:
Concurrent inpatient clinical fax:
Durable medical equipment fax:
Fax all requests for services that require prior authorization to:
Check our Preferred Drug List or see the formulary information on the Pharmacy Information page to use our searchable formulary tool.
Pharmacy prescription drug prior authorization fax:
Pharmacy medical injectable prior authorization fax:
CarelonRx member services phone:
Heathy Blue Dual Advantage
Dual Advantage Prior Authorizations — Utilization Management
The following always require prior authorization:
Elective services provided by or arranged at nonparticipating facilities.
All services you render require prior authorization:
Obtain prior authorization from our vendors
Hi-tech radiology, cardiology, and sleep medicine
AIM Specialty Health®:
Laboratory services and diagnostic testing
866-MY QUEST (866-697-8378)
Dedicated provider line:
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Member Eligibility & Pharmacy Overview
- Provider Manuals and Guides
- Training Academy
- Pharmacy Information
- Electronic Data Interchange (EDI)