Auth Request tool guide: Request authorizations online

When logged in to their Priority Health accounts, participating providers can use the Auth Request tool to:

• Get immediate proof of authorizations automatically for many procedures
• See medical necessity criteria
• Verify authorization requirements and member eligibility/coverage
• Transfer medical records securely
• Check the status of pending authorizations anytime

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Requesting an authorization

When logged in as a participating provider:

1. Click the Request an authorization button on this page, or the link to the Auth Request tool at the bottom of most Provider Manual or Provider Center pages.
2. Choose the requesting provider type, Hospital or Practitioner/Vendor.
3. For Practitioner/Vendor requests, start typing a procedure name or CPT code in the Primary procedure field, then choose the procedure or code from the drop-down of matching services.
4. Select a servicing Facility and a servicing Provider.
5. Click the Go to Clear Coverage^TM or Go to eviCore button that appears.
6. You'll be logged in to Clear Coverage^TM or to eviCore to request the authorization.
7. Return to the "Requesting an authorization" page to request additional authorizations.

Checking authorization status

The authorizations you request will be listed in our Auth Inquiry tool, but you'll find more details if you use Auth Request to go to Clear Coverage^TM or eviCore to check an authorization status.

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Authorizations available in Auth Request

See our Authorization reference list for a summary of what services require authorization under which plans.

Hospital requests authorized through Clear Coverage^TM include:

• Urgent and emergent admissions
• Conversions
• Continuing stays
• Discharges
• Births

Practitioner/vendor requests authorized through Clear Coverage^TM include:

• Scheduled surgeries, services and procedures
• Durable medical equipment (DME)
• Home care (RN, PT, OT, ST, MSW, RD, HHA)*
• Physical, occupational and speech therapy**

Practitioner/vendor requests authorized through eviCore include:

• Musculoskeletal services and surgeries, including arthroscopies  See CPT list at eviCore
• Spinal procedures and surgeries: Open, percutaneous and endoscopic
• Genetic testing guidelines
• Advanced diagnostic imaging: CT/CTA, MRI, MRA, nuclear cardiac studies and PET scans See CPT code list at eviCore. Nuclear cardia studies see CPT list for evicore

For additional information, like training videos, orientation materials and tips visit our resource page 

Services not included

• Services from non-participating providers
• Drug authorizations - use the drug auth request forms
• Behavioral health authorizations
• Skilled nursing, long-term acute care, hospice and inpatient rehabilitation facility admissions - Use the medical authorization request forms 
• Medicare pre-service organization determinations Go to PSOD instructions

Resource and training materials

For Clear Coverage^TM: Go to the training materials page.

For eviCore: Go to the training materials page.

*Standard home care with an RN does not require authorization for the first 30 visits for Commercial and Individual policies. 

**Authorization may be required for Medicare and some self-funded plans after dollar or visit caps for therapy visits for hospital outpatient departments, Part B skilled nursing facilities, home health agencies when billing with type of bill 34X - Services being provided are not under home health plan of care.