Prior authorization

Medical policies and reimbursement guidelines

Service and procedure (CPT) Codes

Prior plan approval

Learn more about receiving written assurance that benefits will be provided by the local plan where the services will be performed or pharmacy programs.

Request prior plan approval

Request approval to provide a medical service, prescription, or supply before a service is rendered.

Services requiring plan approval

Find specific Health Management programs, non-emergency/outpatient services and other procedures that require prior plan approval.

Prescription drugs formulary criteria

Find your patient's Approved Medication List (Formulary) or restricted medications our members use most, the requirements for approval, and the details you must send us to get them approved.

Care management and medical necessity review

Learn about how we work with physicians and members to facilitate the most medically appropriate, cost-effective, quality care for our members.