Prior authorization requirements and payer lookup
An authorization answer is not a coverage, eligibility, or payment answer. Substrate does not submit prior authorization requests.
What prior authorization means
Prior authorization, preauthorization, and precertification are names for the payer process in the HealthCare.gov glossary. Notification is a different label.
A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost.
HealthCare.gov preauthorization glossary
The glossary states why a plan asks for that decision. It also says the decision is not a promise the plan will cover the cost.
Prior authorization lookup
The first step is choosing a payer. This finder lists only guides that are published. Other payers stay on their directory profiles until a guide is published.
- Aetna prior authorization and CPT code lookup
- UnitedHealthcare prior authorization
- Humana prior authorization
- Cigna prior authorization
- Anthem Blue Cross Blue Shield of California prior authorization
- Anthem Blue Cross Blue Shield of Colorado prior authorization
- Anthem Blue Cross Blue Shield of Georgia prior authorization
- Anthem Blue Cross and Blue Shield New Hampshire prior authorization
- Anthem Blue Cross and Blue Shield Nevada prior authorization
- Anthem Blue Cross and Blue Shield Virginia prior authorization
- Blue Cross Blue Shield Oklahoma prior authorization
- Blue Cross and Blue Shield of Montana prior authorization
- Blue Shield of California Promise Health Plan prior authorization
- Blue Shield of California prior authorization
- Peach State Health Plan prior authorization
- Premera Blue Cross of Washington prior authorization
- Regence BlueCross BlueShield of Oregon prior authorization
- Regence BlueCross BlueShield of Utah prior authorization
- Regence BlueShield of Idaho prior authorization
- Regence BlueShield of Washington prior authorization
Anthem routing
Anthem prior authorization depends on the state and product. This finder does not publish an Anthem guide. Open the regional plan from payer lookup and use that plan’s official list.
Blue Cross Blue Shield routing
Blue Cross and Blue Shield prior authorization is plan-specific. Use payer lookup for the regional profile. One official routing page is Blue Cross and Blue Shield of Illinois utilization management.
Blue Cross and Blue Shield of Illinois utilization management
Published resources
- Aetna prior authorization and CPT code lookup
Substrate guide
- UnitedHealthcare prior authorization
Substrate guide
- Humana prior authorization
Substrate guide
- Cigna prior authorization
Substrate guide
- Anthem Blue Cross Blue Shield of California prior authorization
Substrate guide
- Anthem Blue Cross Blue Shield of Colorado prior authorization
Substrate guide
- Anthem Blue Cross Blue Shield of Georgia prior authorization
Substrate guide
- Anthem Blue Cross and Blue Shield New Hampshire prior authorization
Substrate guide
- Anthem Blue Cross and Blue Shield Nevada prior authorization
Substrate guide
- Anthem Blue Cross and Blue Shield Virginia prior authorization
Substrate guide
- Blue Cross Blue Shield Oklahoma prior authorization
Substrate guide
- Blue Cross and Blue Shield of Montana prior authorization
Substrate guide
- Blue Shield of California Promise Health Plan prior authorization
Substrate guide
- Blue Shield of California prior authorization
Substrate guide
- Peach State Health Plan prior authorization
Substrate guide
- Premera Blue Cross of Washington prior authorization
Substrate guide
- Regence BlueCross BlueShield of Oregon prior authorization
Substrate guide
- Regence BlueCross BlueShield of Utah prior authorization
Substrate guide
- Regence BlueShield of Idaho prior authorization
Substrate guide
- Regence BlueShield of Washington prior authorization
Substrate guide
- Predetermination vs prior authorization
Substrate guide
- Prior authorization for MRI
Substrate guide
- Prior authorization process and submission checklist
Substrate guide
- Aetna precertification lists
Official source
- Aetna participating provider precertification list
Official source
- Aetna health care professional forms
Official source
- HealthCare.gov preauthorization glossary
Official source
- Blue Cross and Blue Shield of Illinois utilization management
Official source