Authorization Lookup Tools
- These tools provide outpatient and in-office prior authorization requirements for contracts that follow the Standard Prior Authorization List. They do not cover inpatient services or contracts with precertification requirements.
- Before using these tools, confirm what method of prior authorization a contract uses by viewing the “Additional Details” under “Benefit Details” section on Check Eligibility & Benefits.
- For member contracts that follow the Standard Prior Authorization List, inpatient services require prior authorization except for routine maternity services.
- To view standard prior authorization requirements for procedure/revenue code combinations, visit the Prior Authorization Code Lists page.
- Use the tool below to determine whether or not authorization is required for members based on their specific plan or based on the line of business. This lookup tool for medical services and provider administered drugs only. For a listing of prescription drugs medications, see Prescription Drugs.
Step 1 of 2
Check Member Eligibility
Date of Service
Member ID
Birthdate
Effective
Step 2 of 2
Check Authorization Requirements
Note: Final determination of coverage is subject to the member's benefits and eligibility on the date of service. For member-specific information, please use the tool in Member-Specific Lookup.
