Prior Authorization Lookup Tool

Please verify benefit coverage prior to rendering services. Inpatient services and nonparticipating providers always require prior authorization.

Please note:

  1. This tool is for outpatient services only.
  2. Inpatient services and nonparticipating providers always require prior authorization.
  3. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all noncovered services (i.e., experimental procedures, cosmetic surgery, etc.)— refer to your  Provider Manual  for coverage/limitations.

*Services may be listed as requiring prior authorization that may not be covered benefits for a particular member. Please verify benefit coverage prior to rendering services.

To determine coverage of a particular service or procedure for a specific member:

  • Access eligibility and benefits information on Availity
  • Use the Prior Authorization Lookup Tool within Availity or
  • Call Provider Services at 1-844-594-5072.

To request authorizations:

  1. From the Availity home page, select Patient Registration from the top navigation.
  2. Select Auth/Referral Inquiry or Authorizations.

Interested in becoming a provider in the Healthy Blue network?

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