Prior Authorization & Claims

Prior Authorization Information

Participating Providers
Behavioral Health

Fax all requests for services that require prior authorization/precertification to:
Inpatient: 1-877-434-7578
Outpatient: 1-866-877-5229

Services billed with the following revenue codes ALWAYS require precertification:

  • 0240–0249 — All-inclusive ancillary psychiatric
  • 0901, 0905–0907, 0913, 0917 — Behavioral health treatment services
  • 0944–0945 — Other therapeutic services
  • 0961 — Psychiatric professional fees

Pharmacy

Pharmacy Prior Authorization information is available on this website under the Pharmacy tab.

Services billed with the following revenue codes ALWAYS require precertification:

  • 0632 — Pharmacy multiple sources

The following ALWAYS require precertification:

  • Elective services provided by or arranged at nonparticipating facilities
  • All services billed with the following revenue codes:
    • 0023 — Home health prospective payment system
    • 0570–0572, 0579 — Home health aide
    • 0944–0945 — Other therapeutic services
    • 3101–3109 — Adult day and foster care

Prior authorization - Phone

  • Utilization Management, Behavioral Health and Pharmacy
    • Hoosier Healthwise: 1-866-408-6132
    • Healthy Indiana Plan: 1-844-533-1995
    • Hoosier Care Connect: 1-844-284-1798

Prior authorization - Fax

  • Physical health inpatient and outpatient services: 1-866-406-2803
  • Concurrent reviews for inpatient, skilled nursing facility, long-term acute care hospital and acute inpatient rehabilitation: 1-844-765-5156
  • Outpatient services such as durable medical equipment, pain management, home health care, orthotics, formula, speech therapy, occupational therapy and physical therapy: 1-844-765-5157
  • Page Last Updated: 04/18/18