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Medicaid Providers

Prior authorization requirements

To request or check the status of a prior authorization request or decision for a particular Healthy Blue member, access our Interactive Care Reviewer (ICR) tool via Availity. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate.

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Behavioral health

Services billed with the following revenue codes always require prior authorization:

  • 0240–0249 — All-inclusive ancillary psychiatric
  • 0901, 0905 to 0907, 0913, 0917 — Behavioral health treatment services
  • 0944 to 0945 — Other therapeutic services
  • 0961 — Psychiatric professional fees

Fax all requests for services that require prior authorization to:

  • 1-877-434-7578 (Inpatient)
  • 1-800-505-1193 (Outpatient)

Pharmacy

Check out our Preferred Drug List .

Services billed with the following revenue codes always require prior authorization:

  • 0632 — Pharmacy multiple sources

Provider tools & resources

Interested in becoming a provider in the Healthy Blue network?

We look forward to working with you to provide quality services to our members.