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

GA, TX, UT, VA: 10/1 Magellan Rx Prior Authorization Program for Medical Specialty Drugs

Electronic Authorization Portal FAQ

Availity Registration Guide

July 2022 Authorization Requirement Changes


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

January 2022 IFP/SG Prior Authorization List

NEW - July 2022 IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

Investigational/Experimental Codes

 

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

January 2022 IFP/SG Prior Authorization List

NEW - July 2022 IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

Investigational/Experimental Codes

 

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

January 2022 MA Prior Authorization List

NEW - 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

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

January 2022 IFP/SG Prior Authorization List

NEW - July 2022 IFP/SG Prior Authorization List

Investigational/Experimental Codes

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

January 2022 MA Prior Authorization List

NEW - 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

2022 AIM Codes - Radiology

January 2022 IFP/SG Prior Authorization List

NEW - July 2022 IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

Investigational/Experimental Codes

 

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

January 2022 MA Prior Authorization List

NEW - 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

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

January 2022 IFP/SG Prior Authorization List

NEW - July 2022 IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

Investigational/Experimental Codes

 

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

January 2022 MA Prior Authorization List

NEW - 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

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

To submit an authorization for all services except medical specialty pharmacy services, please either:

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.

 

January 2022 IFP/SG Prior Authorization List

NEW - July 2022 IFP/SG Prior Authorization List

Investigational/Experimental Codes

10/1 Magellan Rx Drug List

Magellan Rx FAQ

Magellan Rx Provider Training

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

January 2022 IFP/SG Prior Authorization List

NEW - July 2022 IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

Investigational/Experimental Codes

 

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

Biomarker Testing Coverage

 

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

 

Bright HealthCare Data Regarding Approvals and Denials of Prior Authorization Requests
Illinois

 


 

Medicare Advantage

Authorization Resources

2022 Resources - Utilization Management Changes

January 2022 MA Prior Authorization List

NEW - 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.

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

January 2022 IFP/SG Prior Authorization List

NEW - July 2022 IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

Investigational/Experimental Codes

 

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

January 2022 MA Prior Authorization List

NEW - 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

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

January 2022 IFP/SG Prior Authorization List

NEW - July 2022 IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

Investigational/Experimental Codes

 

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

January 2022 IFP/SG Prior Authorization List

NEW - July 2022 IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

Investigational/Experimental Codes

 

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

January 2022 IFP/SG Prior Authorization List

NEW - July 2022 IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

Investigational/Experimental Codes

 

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

January 2022 IFP/SG Prior Authorization List

NEW - July 2022 IFP/SG Prior Authorization List

2022 Prior Authorization List Updates

Investigational/Experimental Codes

 

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 an authorization for all services except medical specialty pharmacy services, please either:

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.

January 2022 IFP/SG Prior Authorization List

NEW - July 2022 IFP/SG Prior Authorization List

Investigational/Experimental Codes

10/1 Magellan Rx Drug List

Magellan Rx FAQ

Magellan Rx Provider Training

Forms & Resources

Authorization Fax Form

Authorization Change Request Form

Hemophilia Authorization Request Instructions

Hemophilia Supplemental Authorization Request Form

Hemophilia Case Review Form

Texas Gold Card FAQ

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 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.

January 2022 IFP/SG Prior Authorization List

NEW - July 2022 IFP/SG Prior Authorization List

Investigational/Experimental Codes

10/1 Magellan Rx Drug List

Magellan Rx FAQ

Magellan Rx Provider Training

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 an authorization for all services except medical specialty pharmacy services, please either:

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.

January 2022 IFP/SG Prior Authorization List

NEW - July 2022 IFP/SG Prior Authorization List

Investigational/Experimental Codes

10/1 Magellan Rx Drug List

Magellan Rx FAQ

Magellan Rx Provider Training

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

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