Prior authorization

Providers can submit prior authorization requests via:

Portal: Provider Portal (registration is required)  

• Provider portal training video

Fax: 586-693-4768 for Medical Management

Fax: 512-831-5499 for Medical Drugs/Medical Specialty

Phone: 844-217-8191 (available Monday through Friday, 8:00 a.m. to 6:00 p.m. EST)

Prior authorization resources

• How to obtain a prior authorization
• Overview of services requiring authorization - see below for specific on the code list(s)
• Prior authorization FAQs
• Prior authorization medical form
• Applied Behavior Analysis (ABA) Therapy Request form - NEW FOR 10/10/24
• Prior authorization code list (10/1/24)
• Ascension Insurance Utilization Management Gateway (AIUMG)

Pharmacy prior authorization resources

• Medical Drug/Medical Benefit Prior Authorization form