Medicaid Pre-Auth

We have separate fax numbers for Medicaid and Medicare pre-authorizations. Please make sure you use the correct fax number to expedite your request. 

Medicaid Fax (Physical/Medical): 1-866-467-1316

Medicaid Fax (Behavioral Health Outpatient): 1-833-522-2807
Medicaid Fax (Behavioral Health Inpatient): 1-833-522-2806

Please see section below for Behavioral Health pre-authorization forms.

• Behavioral Health/Substance Abuse authorization requests:
  • Inpatient psych and detox auth requests: 1-800-589-3186 to complete live reviews
  • Behavioral Health Outpatient Treatment Form (PDF)
  • Behavioral Health Inpatient Treatment Form (PDF)
  • Psychological Testing Form (PDF)
  • Behavioral Health Authorization Appeals Fax: 1-866-714-7991

• Vision services need to be verified by Envolve Vision
• Dental Services need to be verified by Envolve Dental
• Prior Authorization for all services except hospital admissions and behavioral health treatment requests, use these forms: 
  • Prior Authorization Form - Outpatient Services (PDF). 
  • Prior Authorization Form - Outpatient Continuation Form (PDF) This form is optional and meant to be used when a request exceeds more than four (4) Procedure Codes.
• Prior authorization is required for hyaluronate derivatives under the medical benefit.
• Prescriptions and pharmaceuticals need to be verified by Medicaid FFS. The Preferred Drug List (PDL) is located on the ForwardHealth website.

Step-Therapy
In some cases, it is required that our members first try a certain medication to treat their medical condition before another medication is covered. For example, Medication A and Medication B both treat the member's medical condition. Medication B may not be covered unless the member tries Medication A first. If Medication A does not work for our member, Medication B will be covered.

Use the form below to check if preauthorization is required. Print a copy of your results for your records.