Prior Authorization for Services
Prior Authorization means your doctor has requested permission for you to get a special service, referral or medication. We must approve these requests before the delivery of services. If you or your provider would like a referral to a service that is not a covered benefit, please call Member Services at 1-866-560-4042 (TTY/TDD: 711) so we can discuss other options available to you.
Some medical and behavioral health services may need Prior Authorization. For example, non‑emergency hospital admissions or others.
Below is a list of services that require prior authorization from Care1st before your healthcare provider can proceed with treatment.
SERVICES THAT REQUIRE A PRIOR AUTHORIZATION |
PRIOR AUTHORIZATION REQUIRED FOR SOME OR ALL OF THE SERVICES? |
|---|---|
Behavioral Health Inpatient Facility |
Yes |
Behavioral Health Residential Facility |
Some services require prior authorization |
Home Care Training to Home Care Clients (HCTC) |
Yes |
Psychological and Neuropsychological Testing |
Yes |
Electroconvulsive Therapy (ECT) |
Yes |
Non‑emergency out of network services/treatments |
Yes |
Some medications, check the list of approved medications (formulary) |
Some services require prior authorization |
MRI, MRA, PET scans |
Yes |
Special lab work, genetics |
Some services require prior authorization |
Surgeries, pre-scheduled |
Some services require prior authorization |
Dialysis |
Some services require prior authorization |
Some Outpatient procedures and surgeries |
Some services require prior authorization |
Transplant |
Some services require prior authorization |
Bio pharmacy (Buy and Bill) |
Some services require prior authorization |
Outpatient Authorization and Drug Coverage forms can be found on our Member Handbooks and Forms page.