Utilization Management

Prior Authorization and Predetermination

This page provides the tools you need to help you determine coverage through prior authorization, predetermination and post-service reviews.

Eligibility and Benefits Reminder:

Check eligibility and benefits first to confirm membership, check coverage, determine if you are in-network for the member’s policy and determine whether prior authorization is required through Availity® or your preferred vendor.

Utilization Management

Utilization management is at the heart of how we help members access the right care, at the right place and at the right time. Learn about the types of utilization management reviews – prior authorization, predetermination and post-service reviewLearn More

How to Request Prior Authorization or Predetermination

Review the process to submit requests for prior authorization and predetermination. Learn More

Prior Authorization Lists

Refer to the lists of services or drug codes that may require prior authorization. Learn More