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Prior Authorization & Claims

Prior Authorization Lookup

Please note the following when using the Prior Authorization Lookup Tool (PLUTO):

  • Inpatient admissions always require prior authorization, and most elective services provided by or arranged at a nonparticipating provider or facility require prior authorization.
  • Drug description search is case sensitive. You must search using generic/chemical ingredient name and use lowercase letters only.
  • All noncontracted providers must submit a prior authorization request for all services except self-referral services and ambulance transports.

Click select to view code requirements

No Procedure Found.

To refine your search, consider the following:

  • Enter a valid 5-digit code for best results
  • If you are searching by code description, limit your search to a single term for more matches
  • The code you are searching for may be invalid or expired. Such procedures are not available for authorization and will be denied.
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