Sign in to Availity to submit prior authorizations. New to Availity? Register and get training.
The
Availity prior authorization tool considers the member's eligibility, coordination of benefits, and whether the member’s plan requires authorization or not. You can check the status of your request through the Auth/Referral Inquiry tool or dashboard.
If the request is denied, we’ll mail a detailed letter to you and the member.
For general code information, use our code check tool. You'll also find the code check tool in Availity in the Premera Payer Space in Resources or through Authorizations & Referrals > Additional Authorizations and Referrals. The code check tool doesn't provide member-specific information.
For links to Individual plan or FEP prior authorization secure tools, view the prior authorization resources page.
Check request status
Ordering/servicing providers or facilities listed on the request (by NPI) can sign in to Availity to check request status through Availity's Auth/Referral
Inquiry tool or dashboard. We typically respond to requests within 1-2 days, but it can take up to 5 days.
Fax or change a prior authorization request
To change an existing request, use the following forms, include the reference number, and fax to 800-843-1114. Check our code list for required supporting documentation.
Fax forms:
Definitions:
Transition of care: If a member is undergoing treatment, but their current provider isn't in the Premera network, they may be able to continue treatment or specific covered services for
a limited time with their existing provider.
Continuity of care: If a member is undergoing treatment, but their current provider is leaving the Premera network, they may be able to continue to receive treatment or care for specific covered services for up to 90 days
with the existing provider.
Letter of agreement: A contract with an out-of-network facility or an out-of-network provider for specific services for a specific member. In-network benefits are provided for the services and the member isn't subject to balance billing.
Benefit-level exception: An exception made to allow in-network benefits for services provided at an out-of-network facility or by and out-of-network provider. The member is still subject to balance billing.
Prior authorization through Carelon, eviCore, and more
Medical services
Dental services
Submit a dental pre-determination request as you’d normally submit a claim through electronic data interchange (EDI),
or by mail to:
Dental Review
PO Box 91059
Seattle, WA 98111-9159
For dental prior authorization for the following services, fax a dental prior authorization form to 425-918-5956.
- Cosmetic and reconstruction services
- General anesthesia and facility services related to dental treatment
- Orthodontic services for treatment of congenital craniofacial anomalies
- Orthognathic surgery
- Temporomandibular joint disorder (TMJ)
Emergencies and extenuating circumstances policy
We know situations can happen that may make it impossible to get prior authorization before treating a patient, or to notify us within 24 hours of admission. If a patient’s emergency prevents you from getting prior authorization, you must notify us within
48 hours following onset of treatment, or as soon as is reasonably possible.
In these situations, contact us before submitting a claim. Follow the recommended practices outlined in the extenuating circumstances policy so that the claim
isn't automatically denied.