Services That Require Prior Authorization

We need to approve the following services before you can get them. This is called prior authorization. Your Case Manager/Agency or health provider will contact us to ask for this approval. If we do not approve them, we will notify you. We will give you information about the grievance and appeals process and your right to a state hearing.

This list may change. You can call Customer Service for the most up to date list of services that require a prior authorization:

  • Substance abuse treatment
  • Psychosocial rehabilitation
  • Supportive housing
  • Specialized residential treatment
  • Most mental health tests done by your Case Manager/Agency or health provider
  • Investigational and experimental procedures and treatments
  • Nonemergency hospital services

We will approve regular service within fourteen (14) calendar days. We or your health provider may need more time to make this decision. If so, we will then take fourteen (14) more calendar days. You or your health provider can ask us for a fast decision (a decision made within 72 hours after receipt of the request for service). You may ask for this if waiting for an approval could put your life or health in danger.