Prior Authorization for Care
A prior authorization is a review of the requested health care service to determine if it is medically necessary at the requested level of care. You must have prior authorization for the following services before getting care:
- Adjunctive dental services
- Home health services (only available in the U.S. and U.S. Territories)
- Hospice care (only available in the U.S. and U.S. Territories)
- Nonemergency inpatient admissions for substance-use disorders or behavioral health
- Outpatient behavioral health care beyond the eighth visit
- Transplants (all solid organ and stem cell)
- TRICARE Extended Care Health Option services
Regional Prior Authorization Requirements
In addition to those services listed above, each region may require prior authorization for additional services:
If overseas, please contact International SOS. Click here for country-specific toll-free numbers.
Requesting Prior Authorization
If you are enrolled in a Prime option, your provider will coordinate for prior authorization on your behalf. If not, you need to coordinate with your regional contractor for prior authorization. You can register on your contractor's site for secure services:
- North Region: Health Net Federal Services
- South Region: Humana Miltary Healthcare Services
- West Region: TriWest Healthcare Alliance
- Overseas: Contact your Regional Call Center
Last Modified:June 18, 2012
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