Prior Authorization for Services
Prior Authorization means your doctor has requested permission for you to get a special service, referral or medication. We must approve these requests before the delivery of services. If you or your provider would like a referral to a service that is not a covered benefit, please call Member Services at 1-866-560-4042 (TTY/TDD: 711) so we can discuss other options available to you.
Some medical and behavioral health services may need Prior Authorization. For example, non‑emergency hospital admissions or others.
Below is a list of services that require prior authorization from Care1st before your healthcare provider can proceed with treatment.
SERVICES THAT REQUIRE A PRIOR AUTHORIZATION | PRIOR AUTHORIZATION REQUIRED FOR SOME OR ALL OF THE SERVICES? |
|---|---|
Behavioral Health Inpatient Facility | Yes |
Behavioral Health Residential Facility | Some services require prior authorization |
Home Care Training to Home Care Clients (HCTC) | Yes |
Psychological and Neuropsychological Testing | Yes |
Electroconvulsive Therapy (ECT) | Yes |
Non‑emergency out of network services/treatments | Yes |
Some medications, check the list of approved medications (formulary) | Some services require prior authorization |
MRI, MRA, PET scans | Yes |
Special lab work, genetics | Some services require prior authorization |
Surgeries, pre-scheduled | Some services require prior authorization |
Dialysis | Some services require prior authorization |
Some Outpatient procedures and surgeries | Some services require prior authorization |
Transplant | Some services require prior authorization |
Bio pharmacy (Buy and Bill) | Some services require prior authorization |
Outpatient Authorization and Drug Coverage forms can be found on our Member Handbooks and Forms page.