Prior Authorization (PA)
Prior authorization (PA) is required for certain covered
services to document the medical necessity for those services. To
determine if a procedure code requires PA, access the fee schedule. Chapter 6 of the
IHCP Provider Manual provides detailed instructions regarding
the PA process and procedures, as does Best Practices: Nonpharmacy
PA on this website.
Submitting a Nonpharmacy PA Request
When you need a PA, complete the appropriate form and fax it to
the appropriate care management organization, as shown in the Prior
Authorization Attachment Address Table. For PA request forms,
see the Forms page on
Appealing a nonpharmacy PA Decision
You can request an appeal of a PA decision. See Chapter 6 of the
IHCP Provider Manual for instructions.
Pharmacy PA Requests
To request pharmacy PA, see the Pharmacy Services
quick link on this website. For more information, see
Chapter 9 of the IHCP Provider Manual.