Prior Authorization (PA)

Overview

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 this website.

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.