The documents below list services and medications for which preauthorization may be required for patients with Medicaid, Medicare Advantage, dual Medicare-Medicaid and commercial coverage. Please review the detailed information at the top of the lists for exclusions and other important information before submitting a preauthorization request.
Summary of Preauthorization and Notification List Changes
List Effective March 22, 2021
Submitting a request with Availity
Optional fax form
State-specific preauthorization forms
State-specific preauthorization statistics