Prior Authorization for Non-Individual Plan Members

  • Starting May 23, providers can use Availity to submit prior authorizations. Sign in to Availity or register and get training. Use your OneHealthPort login after you register.

    To submit a prior authorization request, sign in to Availity. This 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 Availity's Auth/Referral Inquiry tool or dashboard. If the request is denied, we’ll mail a detailed letter to you and the member.

    For training, visit Availity's Help & Training > Get Trained for step-by-step instructions and helpful screenshots. For general code information, use our code check tool. This tool doesn't provide member-specific information.

    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 5 days, but it may take up to 15 days if we need additional information.

    Fax or change a prior authorization request

    Fax prior authorization requests to 800-843-1114, using the following forms. To change an existing request, include the reference number and fax to 800-843-1114. Check our code list for required supporting documentation.

    Fax forms:

    Prior authorization through AIM, 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.