Utilization Management
Beginning 1/1/2023, Bright HealthCare will no longer offer Individual and Family Plans*, and will also no longer offer Medicare Advantage products outside of California. Small Group Plans will remain in Arizona, Colorado, Nebraska, and Tennessee for part of 2023. For more information, go to brighthealthcare.com/markets.
*Except in Texas, for members who purchased plans off the Exchange.
Need to submit an authorization?
Please 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.
If you are submitting a retrospective authorization for services delivered in 2022, please reference the 2022 resources .
For 2023 Service Dates, please select the member’s state below
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
- Fax a completed Prior Authorization Fax Form to 888-319-6479
Prior Authorization List (IFP/SG – Oct 2022)
Investigational/Experimental Codes
Carelon Medical Benefits Management (formerly AIM Specialty Health):
To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit the ProviderPortal, or call Carelon Medical Benefits Management at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays. If authorization changes are needed, please use ProviderPortal or call their call center. Note: Dates of Service cannot be changed or extended in an authorization.
- Resources – Radiology, Radiation Oncology, Genetic Testing
- Codes – Genetic Testing
- Codes - Radiation Oncology
- Codes - Radiology
Forms & Resources
Standard Prior Authorization Form – AZ
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.
Small Group Provider Services Phone Number: 855-521-9364
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
- Fax a completed Prior Authorization Fax Form to 888-319-6479
Prior Authorization List (IFP/SG – Oct 2022)
Investigational/Experimental Codes
Carelon Medical Benefits Management (formerly AIM Specialty Health):
To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit the ProviderPortal, or call Carelon Medical Benefits Management at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays. If authorization changes are needed, please use the ProviderPortal or call their call center. Note: Dates of Service cannot be changed or extended in an authorization.
- Resources – Radiology, Radiation Oncology, Genetic Testing
- Codes – Genetic Testing
- Codes - Radiation Oncology
- Codes - Radiology
Forms & Resources
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.
Small Group Provider Services Phone Number: 855-521-9364
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
- Fax a completed Prior Authorization Fax Form to 888-319-6479
Prior Authorization List (IFP/SG – Oct 2022)
Investigational/Experimental Codes
Carelon Medical Benefits Management (formerly AIM Specialty Health):
To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit the ProviderPortal, or call Carelon Medical Benefits Management at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays. If authorization changes are needed, please use the ProviderPortal or call their call center. Note: Dates of Service cannot be changed or extended in an authorization.
- Resources – Radiology, Radiation Oncology, Genetic Testing
- Codes – Genetic Testing
- Codes - Radiation Oncology
- Codes - Radiology
Forms & Resources
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.
Small Group Provider Services Phone Number: 855-521-9364
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
- Fax a completed Prior Authorization Fax Form to 888-319-6479
Prior Authorization List (IFP/SG – Oct 2022)
Investigational/Experimental Codes
Carelon Medical Benefits Management (formerly AIM Specialty Health):
To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit the ProviderPortal, or call Carelon Medical Benefits Management at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays. If authorization changes are needed, please use the ProviderPortal or call their call center. Note: Dates of Service cannot be changed or extended in an authorization.
- Resources – Radiology, Radiation Oncology, Genetic Testing
- Codes – Genetic Testing
- Codes - Radiation Oncology
- Codes - Radiology
Forms & Resources
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.
Small Group Provider Services Phone Number: 855-521-9364
Individual and Family Plans (IFP)
Authorization Resources
To submit an authorization request, please either:
- Submit electronically via Availity.com (preferred method), OR
- Fax the below Authorization Fax Form to 1-877-438-6832.
October 2022 IFP/SG Prior Authorization List - TX
Investigational/Experimental Codes
Forms & Resources
Authorization Change Request 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
2022 Resources
You may 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.
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
NEW - October 2022 IFP/SG Prior Authorization List
January 2022 IFP/SG Prior Authorization List
July 2022 IFP/SG Prior Authorization List
2022 Prior Authorization List Updates
Investigational/Experimental Codes
Forms & Resources
Hemophilia Authorization Request Instructions
Hemophilia Supplemental Authorization Request 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
NEW - October 2022 IFP/SG Prior Authorization List
January 2022 IFP/SG Prior Authorization List
July 2022 IFP/SG Prior Authorization List
2022 Prior Authorization List Updates
Investigational/Experimental Codes
Forms & Resources
Standard Prior Authorization Form – AZ
Hemophilia Authorization Request Instructions
Hemophilia Supplemental Authorization Request 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
NEW - October 2022 MA Prior Authorization List
January 2022 MA Prior Authorization List
July 2022 MA Prior Authorization List
Forms
Submit an authorization to Bright HealthCare for all MA services (except for Acupuncture and Chiropractic services) by submitting electronically via Availity.com or 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
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
NEW - October 2022 IFP/SG Prior Authorization List
January 2022 IFP/SG Prior Authorization List
July 2022 IFP/SG Prior Authorization List
Investigational/Experimental Codes
Hill Physician Medical Group – Contra Costa County
- Hill Physicians Medical Group Customer Service Phone: 1-800-445-5747
- To request access to the provider portal, complete this form
- Hill Physician Medical Group Website
- Hill Physician Medical Group
Authorization Request Fax Form (Fax numbers are provided at the top of the form)
John Muir Physician Network – Contra Costa County
Submit an authorization to Beacon Health for behavioral health services by visiting their website below:
- Beacon Health Options of California (beaconhealthoptionsca.com)
- Beacon phone number for members and providers: 866-402-7483
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
IFP Provider Services Phone Number: 844-926-4525
Medicare Advantage
Authorization Resources
NEW - October 2022 MA Prior Authorization List
January 2022 MA Prior Authorization List
July 2022 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
January 2022 IFP/SG Prior Authorization List
NEW - October 2022 IFP/SG Prior Authorization List
July 2022 IFP/SG Prior Authorization List
2022 Prior Authorization List Updates
Investigational/Experimental Codes
Forms & Resources
Hemophilia Authorization Request Instructions
Hemophilia Supplemental Authorization Request 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
NEW - October 2022 MA Prior Authorization List
January 2022 MA Prior Authorization List
July 2022 MA Prior Authorization List
Forms
Submit an authorization to Bright HealthCare for all MA services (except for Acupuncture and Chiropractic services) by submitting electronically via Availity.com or 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
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
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
NEW - October 2022 IFP/SG Prior Authorization List
January 2022 IFP/SG Prior Authorization List
July 2022 IFP/SG Prior Authorization List
2022 Prior Authorization List Updates
Investigational/Experimental Codes
Forms & Resources
Hemophilia Authorization Request Instructions
Hemophilia Supplemental Authorization Request 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
NEW - October 2022 MA Prior Authorization List
January 2022 MA Prior Authorization List
July 2022 MA Prior Authorization List
Forms
Submit an authorization to Bright HealthCare for all MA services (except for Acupuncture and Chiropractic services) by submitting electronically via Availity.com or 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
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
To submit an authorization for all services except medical specialty pharmacy services, please either:
- Submit electronically via Availity.com (preferred method), OR
- Fax the below Authorization Fax Form to 1-877-438-6832.
Submit authorization requests for medical specialty pharmacy these drugs to Magellan Rx in the following ways:
For non-urgent requests, please contact Magellan Rx through the provider portal or by phone:
- Provider portal: If the provider contracts directly with Bright HealthCare, log on to MRxGateway.com and click Request Prior Authorizations
- Phone: Call Magellan Rx at 800-424-2804* weekdays between 8:00 a.m. and 6:00 p.m. local time.
For urgent requests**, please call Magellan Rx at 800-424-2804*. Lines are open 24 hours a day, 7 days a week.
*Phone number goes live Oct. 1, 2022.
**Urgent requests mean that following the standard timeframe could seriously jeopardize the life or health of the member or the member’s ability to regain maximum function.
NEW - October 2022 IFP/SG Prior Authorization List - TX, VA, GA, UT
January 2022 IFP/SG Prior Authorization List
July 2022 IFP/SG Prior Authorization List
Investigational/Experimental Codes
Forms & Resources
Authorization Change Request Form
Hemophilia Authorization Request Instructions
Hemophilia Supplemental Authorization Request 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(tel:(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
NEW - October 2022 IFP/SG Prior Authorization List
January 2022 IFP/SG Prior Authorization List
July 2022 IFP/SG Prior Authorization List
2022 Prior Authorization List Updates
Investigational/Experimental Codes
Forms & Resources
Hemophilia Authorization Request Instructions
Hemophilia Supplemental Authorization Request 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
Bright HealthCare Data Regarding Approvals and Denials of Prior Authorization Requests
Illinois
Medicare Advantage
Authorization Resources
2022 Resources - Utilization Management Changes
NEW - October 2022 MA Prior Authorization List
January 2022 MA Prior Authorization List
July 2022 MA Prior Authorization List
Forms
Submit an authorization to Bright HealthCare for all MA services (except for Acupuncture and Chiropractic services) by submitting electronically via Availity.com or 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
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
NEW - October 2022 IFP/SG Prior Authorization List
January 2022 IFP/SG Prior Authorization List
July 2022 IFP/SG Prior Authorization List
2022 Prior Authorization List Updates
Investigational/Experimental Codes
Forms & Resources
Hemophilia Authorization Request Instructions
Hemophilia Supplemental Authorization Request 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
NEW - October 2022 MA Prior Authorization List
January 2022 MA Prior Authorization List
July 2022 MA Prior Authorization List
Forms
Submit an authorization to Bright HealthCare for all MA services (except for Acupuncture and Chiropractic services) by submitting electronically via Availity.com or 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
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
NEW - October 2022 IFP/SG Prior Authorization List
January 2022 IFP/SG Prior Authorization List
July 2022 IFP/SG Prior Authorization List
2022 Prior Authorization List Updates
Investigational/Experimental Codes
Forms & Resources
Hemophilia Authorization Request Instructions
Hemophilia Supplemental Authorization Request 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
NEW - October 2022 IFP/SG Prior Authorization List
January 2022 IFP/SG Prior Authorization List
July 2022 IFP/SG Prior Authorization List
2022 Prior Authorization List Updates
Investigational/Experimental Codes
Forms & Resources
Hemophilia Authorization Request Instructions
Hemophilia Supplemental Authorization Request 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
NEW - October 2022 IFP/SG Prior Authorization List
January 2022 IFP/SG Prior Authorization List
July 2022 IFP/SG Prior Authorization List
2022 Prior Authorization List Updates
Investigational/Experimental Codes
Forms & Resources
Hemophilia Authorization Request Instructions
Hemophilia Supplemental Authorization Request 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
NEW - October 2022 IFP/SG Prior Authorization List
January 2022 IFP/SG Prior Authorization List
July 2022 IFP/SG Prior Authorization List
2022 Prior Authorization List Updates
Investigational/Experimental Codes
Forms & Resources
Hemophilia Authorization Request Instructions
Hemophilia Supplemental Authorization Request 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 an authorization for all services except medical specialty pharmacy services, please either:
- Submit electronically via Availity.com (preferred method), OR
- Fax the below Authorization Fax Form to 1-877-438-6832.
Submit authorization requests for medical specialty pharmacy these drugs to Magellan Rx in the following ways:
For non-urgent requests, please contact Magellan Rx through the provider portal or by phone:
- Provider portal: If the provider contracts directly with Bright HealthCare, log on to MRxGateway.com and click Request Prior Authorizations
- Phone: Call Magellan Rx at 800-424-2804* weekdays between 8:00 a.m. and 6:00 p.m. local time.
For urgent requests**, please call Magellan Rx at 800-424-2804*. Lines are open 24 hours a day, 7 days a week.
NEW - October 2022 IFP/SG Prior Authorization List - TX, VA, GA, UT
January 2022 IFP/SG Prior Authorization List
July 2022 IFP/SG Prior Authorization List
Investigational/Experimental Codes
Forms & Resources
Authorization Change Request Form
Hemophilia Authorization Request Instructions
Hemophilia Supplemental Authorization Request 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 an authorization for all services except medical specialty pharmacy services, please either:
- Submit electronically via Availity.com (preferred method), OR
- Fax the below Authorization Fax Form to 1-877-438-6832.
Submit authorization requests for medical specialty pharmacy these drugs to Magellan Rx in the following ways:
For non-urgent requests, please contact Magellan Rx through the provider portal or by phone:
- Provider portal: If the provider contracts directly with Bright HealthCare, log on to MRxGateway.com and click Request Prior Authorizations
- Phone: Call Magellan Rx at 800-424-2804* weekdays between 8:00 a.m. and 6:00 p.m. local time.
For urgent requests**, please call Magellan Rx at 800-424-2804*. Lines are open 24 hours a day, 7 days a week.
NEW - October 2022 IFP/SG Prior Authorization List - TX, VA, GA, UT
January 2022 IFP/SG Prior Authorization List
July 2022 IFP/SG Prior Authorization List
Investigational/Experimental Codes
Forms & Resources
Authorization Change Request Form
Hemophilia Authorization Request Instructions
Hemophilia Supplemental Authorization Request 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 an authorization for all services except medical specialty pharmacy services, please either:
- Submit electronically via Availity.com (preferred method), OR
- Fax the below Authorization Fax Form to 1-877-438-6832.
Submit authorization requests for medical specialty pharmacy these drugs to Magellan Rx in the following ways:
For non-urgent requests, please contact Magellan Rx through the provider portal or by phone:
- Provider portal: If the provider contracts directly with Bright HealthCare, log on to MRxGateway.com and click Request Prior Authorizations
- Phone: Call Magellan Rx at 800-424-2804* weekdays between 8:00 a.m. and 6:00 p.m. local time.
For urgent requests**, please call Magellan Rx at 800-424-2804*. Lines are open 24 hours a day, 7 days a week.
NEW - October 2022 IFP/SG Prior Authorization List - TX, VA, GA, UT
January 2022 IFP/SG Prior Authorization List
July 2022 IFP/SG Prior Authorization List
Investigational/Experimental Codes
Forms & Resources
Authorization Change Request Form
Hemophilia Authorization Request Instructions
Hemophilia Supplemental Authorization Request 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
- Log in to Availity.com
- Click Patient Registration | Authorization & Referrals in the top left of the screen
- The Authorization & Referrals page displays
- 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
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