Precertification Information

Participating and nonparticipating durable medical equipment (DME) providers:

For durable medical equipment (DME), outpatient rehabilitation (physical therapy/occupational therapy/speech therapy), pain management, home care, home infusion or hyperbaric treatment, and wound care, please fax to 1-866-920-8362.

All other precertification requests (including elective inpatient or outpatient services):

Use the following:
Fax: 1-800-964-3627
Phone: 1-844-396-2330

Behavioral health:

Fax all requests for services requiring precertification to:
Inpatient: 1-877-434-7578
Outpatient: 1-800-505-1193

Services billed with the following revenue codes always require precertification:

  • 0240-0249 — all-inclusive ancillary psychiatric
  • 0901, 0905-0907, 0913 and 0917 — behavioral health treatment services
  • 0944-0945 — other therapeutic services
  • 0961 — psychiatric professional fees

Pharmacy

Check our Preferred Drug List.

Services billed with the following revenue codes always require precertification:

  • 0632 — pharmacy multiple sources
  • Medicare and Long-Term Services and Supports

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 and 0579 — home health aide
    • 0944-0945 — other therapeutic services
    • 3101-3109 — adult day and foster care