Authorization, eligibility and benefits are important things to know to ensure you provide the best service to your patients. We provide several options for you to get this information quickly and accurately.
Authorization
To search for authorization by code, scroll to use the Prior Authorization Lookup Tool below.
Medical and Behavioral Health Services
When you request prior authorization (PA) from us, we want the process to be fast, easy and accurate. We use the Cohere Health platform to provide you with a powerful tool to accelerate the PA process and expand real-time approvals.
You will still sign-on through My Insurance Manager so you can begin the process for medical services, but the portal will route you to the new web-based application, powered by Cohere Health, to enhance the efficiency of PA decisions.
Note: All clinical decisions are made by Healthy Blue.
Eligibility and Benefits
To get eligibility and benefits for a patient, you can:
- Call Provider Service at 866-757-8286.
- Use My Insurance Manager.
Prior Authorization Lookup Tool
Please verify benefit coverage prior to rendering services. Inpatient services and nonparticipating providers always require prior authorization (PA).
Please note:
- Enter one CPT code at a time into the search.
- This tool is for outpatient services only.
- Inpatient services and nonparticipating providers always require PA.
- This tool does not reflect benefits coverage nor does it include an exhaustive list of all noncovered services (that is, experimental procedures, cosmetic surgery, etc.). Refer to your provider manual for coverage and limitations.
- For specialty pharmacy codes, visit the Pharmacy page and use the Medical Specialty Drug List Lookup Tool.
- These codes are valid as of 8/1/2024.
Disclaimer: Healthy Blue attempts to provide the most current information for the Prior Authorization Lookup Tool. Please note that this information may be subject to change, and a prior authorization is NOT a guarantee of payment. Reimbursement depends on a number of factors, including but not limited to member eligibility on the date of service, coverage limitations and exclusions, provider contracts, and correct coding and billing for the services at issue.