Utilization Management

Utilization Management is the evaluation of the medical necessity, appropriateness, and efficiency of use of health care services, procedures, and facilities. It includes a variety of strategies designed to ensure patients receive the right service by the right provider, at the right time, at the right level of care.

 


 

News and announcements

New prior authorization program for medical specialty drugs (excludes California)

 


Need to submit an authorization?

Use the Authorization Navigator. The Authorization Navigator is an online tool to help you determine if an authorization is needed and where/how to submit the authorization depending on your location or specialty.

You may also review the Authorization Submission Guide for an overview of how and where to submit an authorization, based on the member's state and service type.


 

Below, you’ll find an overview of Utilization Management programs for 2021 and 2022.

Having trouble submitting an authorization to AIM? Try these steps.

March 2022 Single Fax Form Announcement

How to know if your member is IFP, SG, or MA

Continuity of Care/Transition of Care Form

For retrospective MA authorization for services delivered in 2021, fax the authorization request to: 1-888-319-6479. Fax forms are found .

Return to Resources Home

For 2022 Services Dates, please select the member’s state below

Individual and Family Plans

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please either:

  • Submit electronically via Availity.com (preferred method), OR
  • Use the below fax forms.

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit AIM’s ProviderPortal, or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays. If authorization changes are needed, please use AIM’s ProviderPortal or call their call center. Note: Dates of Service cannot be changed or extended in an authorization.

 

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

 

Forms & Resources

Prior Authorization Fax Form

Authorization Change Request Form - All services EXCEPT diagnostic/advanced imaging, radiation oncology, and genetic testing

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

If you need to change a facility name, dates of service or number of units/days on an existing authorization, utilize the portal on Availity.com or fax the Authorization Change Request Form to 1-888-319-6479. This form is NOT intended to add codes to an existing authorization. For approval of additional services, please submit a new authorization request.

IFP Provider Services Phone Number: 866-239-7191

Individual and Family Plans (IFP) or Small Group

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please either:

  • Submit electronically via Availity.com (preferred method), OR
  • Use the below fax forms.

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit AIM’s ProviderPortal, or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays. If authorization changes are needed, please use AIM’s ProviderPortal or call their call center. Note: Dates of Service cannot be changed or extended in an authorization.

 

2022 Redesigned Authorization Portal Resources

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

 

Forms & Resources

Standard Prior Authorization Form – AZ

Prior Authorization Fax Form

Authorization Change Request Form - All services EXCEPT diagnostic/advanced imaging, radiation oncology, and genetic testing

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

If you need to change a facility name, dates of service or number of units/days on an existing authorization, utilize the portal on Availity.com or fax the Authorization Change Request Form to 1-888-319-6479. This form is NOT intended to add codes to an existing authorization. For approval of additional services, please submit a new authorization request.

IFP Provider Services Phone Number: 866-239-7191

Small Group Provider Services Phone Number: 855-521-9364

 


 

Medicare Advantage

Authorization Resources

2022 Resources - Utilization Management Changes

MA Prior Authorization List

 

Forms

Submit an authorization to Bright HealthCare for all MA services (except for Acupuncture and Chiropractic services) by faxing the below form to 1-888-337-2174.

MA Authorization Fax Form – All services EXCEPT Acupuncture and Chiropractic.

MA Patient Referral Form – All services EXCEPT Acupuncture and Chiropractic.

MA Patient Referral Instructions.

Authorization Change Request Form - All services EXCEPT Acupuncture and Chiropractic.

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

If you need to change a facility name, dates of service or number of units/days on an existing authorization, call 844-926-4522 or fax the Authorization Change Request Form to 1-888-337-2174. This form is NOT intended to add codes to an existing authorization. For approval of additional services, please submit a new authorization request.

MA Fax Number: 1-888-337-2174

MA Provider Services Phone Number: 1-844-926-4522

Submit an authorization to American Specialty Health (ASH) for Acupuncture and Chiropractic services by going to ASH’s website and using their online portal or fax forms.

For questions about an authorization or to change an authorization, contact ASH Provider Services at (800) 972-4226.

American Specialty Health Contact Information:

Provider Services phone number: (800) 972-4226 | Fax Number: (877) 304-2746

Individual and Family Plans (IFP)

Authorization Resources

Submit an authorization to American Specialty Health (ASH) for Acupuncture and Chiropractic services by going to ASH’s website and using their online portal or fax forms.

For questions about an authorization or to change an authorization, contact ASH Provider Services at (800) 972-4226.

American Specialty Health Contact Information:

Provider Services phone number: (800) 972-4226 | Fax Number: (877) 304-2746

IFP/SG Prior Authorization List

Hill Physician Medical Group – Contra Costa County

John Muir Physician Network – Contra Costa County

Submit an authorization to Beacon Health for behavioral health services by visiting their website below:

To submit an authorization for out-of network care or transplant services to Bright HealthCare, fax the form below to 1-877-438-6832.

 

Forms

Authorization Fax Form

IFP Provider Services Phone Number: 844-926-4525

 

Medicare Advantage

Authorization Resources

MA Prior Authorization List

MA Provider Services Phone Number: 844-926-4522

 

Individual and Family Plans (IFP) or Small Group

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please either:

  • Submit electronically via Availity.com (preferred method), OR
  • Use the below fax forms.

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit AIM’s ProviderPortal, or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays. If authorization changes are needed, please use AIM’s ProviderPortal or call their call center. Note: Dates of Service cannot be changed or extended in an authorization.

 

2022 Redesigned Authorization Portal Resources

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

 

Forms & Resources

Prior Authorization Fax Form

Authorization Change Request Form - All services EXCEPT diagnostic/advanced imaging, radiation oncology, and genetic testing

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

If you need to change a facility name, dates of service or number of units/days on an existing authorization, utilize the portal on Availity.com or fax the Authorization Change Request Form to 1-888-319-6479. This form is NOT intended to add codes to an existing authorization. For approval of additional services, please submit a new authorization request.

IFP Provider Services Phone Number: 866-239-7191

Small Group Provider Services Phone Number: 855-521-9364

 


 

Medicare Advantage

Authorization Resources

2022 Resources - Utilization Management Changes

MA Prior Authorization List

 

Forms

Submit an authorization to Bright HealthCare for all MA services (except for Acupuncture and Chiropractic services) by faxing the below form to 1-888-337-2174.

MA Authorization Fax Form – All services EXCEPT Acupuncture and Chiropractic.

MA Patient Referral Form – All services EXCEPT Acupuncture and Chiropractic.

MA Patient Referral Instructions.

Authorization Change Request Form - All services EXCEPT Acupuncture and Chiropractic.

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

If you need to change a facility name, dates of service or number of units/days on an existing authorization, call 844-926-4522 or fax the Authorization Change Request Form to 1-888-337-2174. This form is NOT intended to add codes to an existing authorization. For approval of additional services, please submit a new authorization request.

MA Fax Number: 1-888-337-2174

MA Provider Services Phone Number: 1-844-926-4522

Submit an authorization to American Specialty Health (ASH) for Acupuncture and Chiropractic services by going to ASH’s website and using their online portal or fax forms.

For questions about an authorization or to change an authorization, contact ASH Provider Services at (800) 972-4226.

American Specialty Health Contact Information:

Provider Services phone number: (800) 972-4226 | Fax Number: (877) 304-2746

 

Bright HealthCare Data Regarding Approvals and Denials of Prior Authorization Requests

Colorado

Per prior authorization bill HB19-1211 or C.R.S. § 10-16-112.5, the state of Colorado requires carriers and organizations to publish prior authorization data.

Individual and Family Plans (IFP)

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please either:

  • Submit electronically via Availity.com (preferred method), OR
  • Use the below fax forms.

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit AIM’s ProviderPortal, or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays. If authorization changes are needed, please use AIM’s ProviderPortal or call their call center. Note: Dates of Service cannot be changed or extended in an authorization.

 

2022 Redesigned Authorization Portal Resources

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

 

Forms & Resources

Prior Authorization Fax Form

Authorization Change Request Form - All services EXCEPT diagnostic/advanced imaging, radiation oncology, and genetic testing

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

If you need to change a facility name, dates of service or number of units/days on an existing authorization, utilize the portal on Availity.com or fax the Authorization Change Request Form to 1-888-319-6479. This form is NOT intended to add codes to an existing authorization. For approval of additional services, please submit a new authorization request.

IFP Provider Services Phone Number: 866-239-7191

 


 

Medicare Advantage

Authorization Resources

2022 Resources - Utilization Management Changes

MA Prior Authorization List

 

Forms

Submit an authorization to Bright HealthCare for all MA services (except for Acupuncture and Chiropractic services) by faxing the below form to 1-888-337-2174.

MA Authorization Fax Form – All services EXCEPT Acupuncture, Chiropractic and Therapeutic Massage.

Authorization Change Request Form - All services EXCEPT Acupuncture and Chiropractic.

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

If you need to change a facility name, dates of service or number of units/days on an existing authorization, call 844-926-4522 or fax the Authorization Change Request Form to 1-888-337-2174. This form is NOT intended to add codes to an existing authorization. For approval of additional services, please submit a new authorization request.

MA Fax Number: 1-888-337-2174

MA Provider Services Phone Number: 1-844-926-4522

Submit an authorization to American Specialty Health (ASH) for Acupuncture and Chiropractic services by going to ASH’s website and using their online portal or fax forms.

For questions about an authorization or to change an authorization, contact ASH Provider Services at (800) 972-4226.

American Specialty Health Contact Information:

Provider Services phone number: (800) 972-4226 | Fax Number: (877) 304-2746

Individual and Family Plans (IFP)

Authorization Resources

Submit an authorization by faxing the below form to 1-877-438-6832.

IFP/SG Prior Authorization List

Forms & Resources

Authorization Fax Form

Authorization Change Request Form

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

If you need to change a facility name, dates of service or number of units/days on an existing authorization, call 844-926-4525 or fax the Authorization Change Request Form to 1-877-438-6832. This form is NOT intended to add codes to an existing authorization. For approval of additional services, please submit a new authorization request.

IFP Provider Services Phone Number: 844-926-4525

Individual and Family Plans (IFP)

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please either:

  • Submit electronically via Availity.com (preferred method), OR
  • Use the below fax forms.

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit AIM’s ProviderPortal, or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays. If authorization changes are needed, please use AIM’s ProviderPortal or call their call center. Note: Dates of Service cannot be changed or extended in an authorization.

 

2022 Redesigned Authorization Portal Resources

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

 

Forms & Resources

Prior Authorization Fax Form

Authorization Change Request Form - All services EXCEPT diagnostic/advanced imaging, radiation oncology, and genetic testing

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

 

If you need to change a facility name, dates of service or number of units/days on an existing authorization, utilize the portal on Availity.com or fax the Authorization Change Request Form to 1-888-319-6479. This form is NOT intended to add codes to an existing authorization. For approval of additional services, please submit a new authorization request.

 

To submit a referral in Illinois, go to the authorization portal via Availity.com and click on the “referrals” tab. Providers may also submit a referral via fax.

 

IFP Provider Services Phone Number: 866-239-7191

 


 

Medicare Advantage

Authorization Resources

2022 Resources - Utilization Management Changes

MA Prior Authorization List

 

Forms

Submit an authorization to Bright HealthCare for all MA services (except for Acupuncture and Chiropractic services) by faxing the below form to 1-888-337-2174.

MA Authorization Fax Form – All services EXCEPT Acupuncture and Chiropractic.

MA Patient Referral Form – All services EXCEPT Acupuncture and Chiropractic.

MA Patient Referral Instructions.

Authorization Change Request Form - All services EXCEPT Acupuncture and Chiropractic.

Illinois Referral Fax Form.

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

If you need to change a facility name, dates of service or number of units/days on an existing authorization, call 844-926-4522 or fax the Authorization Change Request Form to 1-888-337-2174. This form is NOT intended to add codes to an existing authorization. For approval of additional services, please submit a new authorization request.

MA Fax Number: 1-888-337-2174

MA Provider Services Phone Number: 1-844-926-4522

Submit an authorization to American Specialty Health (ASH) for Acupuncture and Chiropractic services by going to ASH’s website and using their online portal or fax forms.

For questions about an authorization or to change an authorization, contact ASH Provider Services at (800) 972-4226.

American Specialty Health Contact Information:

Provider Services phone number: (800) 972-4226 | Fax Number: (877) 304-2746

 


 

Clinical Criteria

Written clinical criteria is available through the provider portal and the member hub

Individual and Family Plans or Small Group

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please either:

  • Submit electronically via Availity.com (preferred method), OR
  • Use the below fax forms.

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit AIM’s ProviderPortal, or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays. If authorization changes are needed, please use AIM’s ProviderPortal or call their call center. Note: Dates of Service cannot be changed or extended in an authorization.

 

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

 

Forms & Resources

Prior Authorization Fax Form

Authorization Change Request Form - All services EXCEPT diagnostic/advanced imaging, radiation oncology, and genetic testing

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

If you need to change a facility name, dates of service or number of units/days on an existing authorization, utilize the portal on Availity.com or fax the Authorization Change Request Form to 1-888-319-6479. This form is NOT intended to add codes to an existing authorization. For approval of additional services, please submit a new authorization request.

IFP Provider Services Phone Number: 866-239-7191

Small Group Provider Services Phone Number: 855-521-9364

Medicare Advantage

Authorization Resources

2022 Resources - Utilization Management Changes

MA Prior Authorization List

 

Forms

Submit an authorization to Bright HealthCare for all MA services (except for Acupuncture and Chiropractic services) by faxing the below form to 1-888-337-2174.

MA Authorization Fax Form – All services EXCEPT Acupuncture and Chiropractic.

MA Patient Referral Form – All services EXCEPT Acupuncture and Chiropractic.

MA Patient Referral Instructions.

Authorization Change Request Form - All services EXCEPT Acupuncture and Chiropractic.

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

If you need to change a facility name, dates of service or number of units/days on an existing authorization, call 844-926-4522 or fax the Authorization Change Request Form to 1-888-337-2174. This form is NOT intended to add codes to an existing authorization. For approval of additional services, please submit a new authorization request.

MA Fax Number: 1-888-337-2174

MA Provider Services Phone Number: 1-844-926-4522

Submit an authorization to American Specialty Health (ASH) for Acupuncture and Chiropractic services by going to ASH’s website and using their online portal or fax forms.

For questions about an authorization or to change an authorization, contact ASH Provider Services at (800) 972-4226.

American Specialty Health Contact Information:

Provider Services phone number: (800) 972-4226 | Fax Number: (877) 304-2746

Individual and Family Plans or Small Group

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please either:

  • Submit electronically via Availity.com (preferred method), OR
  • Use the below fax forms.

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit AIM’s ProviderPortal, or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays. If authorization changes are needed, please use AIM’s ProviderPortal or call their call center. Note: Dates of Service cannot be changed or extended in an authorization.

 

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

 

Forms & Resources

Prior Authorization Fax Form

Authorization Change Request Form - All services EXCEPT diagnostic/advanced imaging, radiation oncology, and genetic testing

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

If you need to change a facility name, dates of service or number of units/days on an existing authorization, utilize the portal on Availity.com or fax the Authorization Change Request Form to 1-888-319-6479. This form is NOT intended to add codes to an existing authorization. For approval of additional services, please submit a new authorization request.

IFP Provider Services Phone Number: 866-239-7191

Small Group Provider Services Phone Number: 855-521-9364

Individual and Family Plans (IFP)

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please either:

  • Submit electronically via Availity.com (preferred method), OR
  • Use the below fax forms.

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit AIM’s ProviderPortal, or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays. If authorization changes are needed, please use AIM’s ProviderPortal or call their call center. Note: Dates of Service cannot be changed or extended in an authorization.

 

2022 Redesigned Authorization Portal Resources

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

 

Forms & Resources

Prior Authorization Fax Form

Authorization Change Request Form - All services EXCEPT diagnostic/advanced imaging, radiation oncology, and genetic testing

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

If you need to change a facility name, dates of service or number of units/days on an existing authorization, utilize the portal on Availity.com or fax the Authorization Change Request Form to 1-888-319-6479. This form is NOT intended to add codes to an existing authorization. For approval of additional services, please submit a new authorization request.

IFP Provider Services Phone Number: 866-239-7191

Individual and Family Plans

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please either:

  • Submit electronically via Availity.com (preferred method), OR
  • Use the below fax forms.

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit AIM’s ProviderPortal, or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays. If authorization changes are needed, please use AIM’s ProviderPortal or call their call center. Note: Dates of Service cannot be changed or extended in an authorization.

 

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

 

Forms & Resources

Prior Authorization Fax Form

Authorization Change Request Form - All services EXCEPT diagnostic/advanced imaging, radiation oncology, and genetic testing

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

If you need to change a facility name, dates of service or number of units/days on an existing authorization, utilize the portal on Availity.com or fax the Authorization Change Request Form to 1-888-319-6479. This form is NOT intended to add codes to an existing authorization. For approval of additional services, please submit a new authorization request.

IFP Provider Services Phone Number: 866-239-7191

Individual and Family Plans or Small Group

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please either:

  • Submit electronically via Availity.com (preferred method), OR
  • Use the below fax forms.

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit AIM’s ProviderPortal, or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays. If authorization changes are needed, please use AIM’s ProviderPortal or call their call center. Note: Dates of Service cannot be changed or extended in an authorization.

 

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

 

Forms & Resources

Prior Authorization Fax Form

Authorization Change Request Form - All services EXCEPT diagnostic/advanced imaging, radiation oncology, and genetic testing

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

If you need to change a facility name, dates of service or number of units/days on an existing authorization, utilize the portal on Availity.com or fax the Authorization Change Request Form to 1-888-319-6479. This form is NOT intended to add codes to an existing authorization. For approval of additional services, please submit a new authorization request.

IFP Provider Services Phone Number: 866-239-7191

Small Group Provider Services Phone Number: 855-521-9364

Individual and Family Plans (IFP)

Authorization Resources

Submit an authorization by faxing the below form to 1-877-438-6832.

IFP/SG Prior Authorization List

Forms & Resources

Authorization Fax Form

Authorization Change Request Form

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

If you need to change a facility name, dates of service or number of units/days on an existing authorization, call 844-926-4525 or fax the Authorization Change Request Form to 1-877-438-6832. This form is NOT intended to add codes to an existing authorization. For approval of additional services, please submit a new authorization request.

IFP Provider Services Phone Number: 844-926-4525

Individual and Family Plans (IFP)

Authorization Resources

Submit an authorization by faxing the below form to 1-877-438-6832.

IFP/SG Prior Authorization List

Forms & Resources

Authorization Fax Form

Authorization Change Request Form

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

If you need to change a facility name, dates of service or number of units/days on an existing authorization, call 844-926-4525 or fax the Authorization Change Request Form to 1-877-438-6832. This form is NOT intended to add codes to an existing authorization. For approval of additional services, please submit a new authorization request.

IFP Provider Services Phone Number: 844-926-4525

Individual and Family Plans (IFP)

Authorization Resources

Submit an authorization by faxing the below form to 1-877-438-6832.

IFP/SG Prior Authorization List

Forms & Resources

Authorization Fax Form

Authorization Change Request Form

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

If you need to change a facility name, dates of service or number of units/days on an existing authorization, call 844-926-4525 or fax the Authorization Change Request Form to 1-877-438-6832. This form is NOT intended to add codes to an existing authorization. For approval of additional services, please submit a new authorization request.

IFP Provider Services Phone Number: 844-926-4525


2021 Resources

  1. Log in to Availity.com
  2. Click Patient Registration | Authorization & Referrals in the top left of the screen
  3. The Authorization & Referrals page displays
  4. Click Auth/Referral Inquiry or Authorizations to begin an electronic authorization request

For detailed step-by-step instructions on submitting authorizations electronically, please review the user guide on Availity.com under payer spaces.

Commercial Plans Prior Authorization List - Florida Markets

Commercial Plans Prior Authorization List - NON-Florida Markets

The authorization change request form can be used when Providers need to change any of the following items on an existing authorization.

  1. Servicing Provider or Facility Name

  2. Dates of Service for a planned procedure

  3. The number of days/units/visits needed for a specific service

Use this form when you need to change information on a pending or approved authorization. Note that the form is not intended to add codes to an authorization. For an approval of additional services, please submit a new authorization request.

Colorado

Per prior authorization bill HB19-1211 or C.R.S. § 10-16-112.5, the state of Colorado requires carriers and organizations to publish prior authorization data.