Prior Authorization
What is a Prior Authorization or Pre-authorization?
Certain medical procedures and medications require approval before you will be able to receive treatment. The prior approval process is called pre-authorization, or prior authorization (PA).
Prior authorization allows for a personal review of your treatment within the context of your existing health issues, medications and treatments.
Reasons for Prior Authorization include:
- Review of treatment options and any related risks to the treatment
- Manage Costs - Prior Authorization helps ensure that you have insurance coverage for a procedure, treatment or service
- Avoid excess and waste - utilization management review for inappropriate or unnecessary medical treatments
Procedures, Products and Treatment requiring Prior Authorization
- A current list of Medical Services requiring Prior Authorization can be viewed on the Medical Services requiring Prior Authorization
- A current list of Pharmacy Services and Products requiring Prior Authorization for Commercial and Individual plans can be viewed on the Medical Pharmacy Prior Authorization List
- A current list of Pharmacy Services and Products requiring Prior Authorization for Healthy U Medicaid can be viewed on the Healthy U Medical Pharmacy Prior Authorization List
- A current list of Medical Services and Part B Pharmacy Services requiring Prior Authorization for Advantage U can be viewed on the Advantage U Medical and Part B Pharmacy Prior Authorization List
Upcoming Changes to Codes Requiring Prior Authorization
No changes are currently scheduled for the next 60 days.
Prior Authorization (Medical Utilization Management Review) & Notifications
In order to help you assist patients in a timely and efficient manner; please use the Prior Authorization Request Application. The Prior Authorization application replaces all previous and existing U of U Health Plans Medical Utilization forms EXCEPT for SNF, Acute Rehab and LTAC requests. For SNF, Acute Rehab and LTAC requests, please download and use the SNF, Acute Rehab and LTAC Prior Authorization form.
Prior Authorization requests via Fax
Updated: If you need to submit Prior Authorization requests via Fax, please use the updated number(s)
| Prior Authorization Request | Fax Number |
|---|---|
| Prior Authorization | 801-213-1358 |
| Inpatient Notification, SNF & Rehab | 801-213-2132 |
| Behavioral Health & Substance Use Treatment | 801-213-2132 |
| Appeals | 801-587-9985 |
| Medical Pharmacy | 801-213-1547 |
Updated: Please note the current PDF forms are suitable for faxing
Medical Documentation Submission Form
Along with the missing documentation, please use the form for MDOC claim denials.
Complete the form online, upload the required documentation files, and click “Submit,” instead of faxing the form.