Preauthorization and Predetermination
This page provides the tools you need to help you determine coverage through preauthorization, 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 preauthorization is required through Availity® or your preferred vendor.
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 – preauthorization, predetermination and post-service review. Learn More
How to Request Preauthorization or Predetermination
Review the process to submit requests for preauthorization and predetermination. Learn More
Refer to the lists of services or drug codes that may require preauthorization. Learn More