You Can Now Print Your Referrals & Authorizations

 To access and print your letters, follow these steps:

Click on the small triangle in the left column to expand the letter details. Next, locate the line containing the word "Status" and click on it. This action will activate the "OPEN PDF" button. Once the "OPEN PDF" button turns blue, click on it to open your letter.

Please note that authorization letters from BHCP and Optum will not be available for viewing or printing in ProAuth. For these letters, you must log into their respective portals to access and print the authorizations they manage.

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Authorizations & Referrals

Generations Advantage Part B Step Therapy

Information relating to referrals and authorizations of certain prescription medications.

Drugs & Biologics Changes for January 1, 2024

Prior authorization is required for all Step Therapy drugs, preferred and non-preferred.*

*The only preferred drugs not requiring authorization are:

  • Synvisc®, Synvisc-One®, Orthovisc®, and Durolane®
  • Avastin® is preferred for ocular indications only and does not require authorization
For a list of drugs please see our 2024 Part B Step Therapy Drug List (PDF)

Reminder: Effective July 1, 2024 prior authorization for the following PET and SPECT imaging services will be required for Generations Advantage and USHFP members.

ProAuth will be open to receive requests for these services on Monday, June 17th.

Authorization Requirement Information & Codes
  
New authorization requirements for Generations Advantage and USFHP:

Cardiac PETs: 78429, 78430, 78431, 78432, 78433, 78459, 78491, 78492, 78814

Cardiac SPECTs: 78451, 78452, 78453, 78454 

New authorization requirements for USFHP and Continuing authorization requirements for Generation Advantage, but no longer submitted to eviCore:

Non-Cardiac PETs: 78608, 78811, 78812, 78813, 78814, 78815, 78816

Non-Cardiac SPECTs: 78071, 78072, 78803, 78830, 78831, 78832 

ProAuth™ Dashboard – Helpful Hints
  • To be able to view Authorizations or Referrals the Requesting or Servicing Provider must be an exact match to an option in your Provider Filter.
  • Your Provider Filter shows what your access permissions are for viewing authorizations and referrals.
  • You can view requests you entered as the Requesting Provider AND requests entered by other health systems that have been sent to you as the Servicing Provider.
  • For most health systems the Provider Filter contains practice locations and facilities and does NOT contain individual providers.


Best Practice: Enter the Practice Location of the requesting provider into the Requesting Provider field and to enter the Requesting Provider's name in the Notes

See step by step instructions for entering your imaging requests here: ProAuth™ Instructions for PET and SPECT Imaging (PDF)

 

TruCare ProAuth™
Access training materials, request and review authorizations and referrals with the ProAuth tool.
Optum™
Generations Advantage providers requesting authorizations for specialty drug, oncology drugs and radiation services at PAR servicing locations.
Provider Registration

To use our online tool Trucare ProAuth or Optum, you must register for an account if you do not already have one. Par and Non-Par providers can register and use our authorization tool.

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Prior Authorization | Instructions


For prescriptions, please visit our Pharmacy page.

For mental health/substance abuse services, call BHCP:

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USFHP Referrals | Instructions

Starting November 1, 2024, you will be able to enter referrals to participating specialists through ProAuth. For more information tap on the following link to visit our referral program page.

Make sure you are signed in to view step-by-step instructions to ensure you have entered all information needed to have your referral immediately approved USFHP ProAuth™ Referral Entry Instructions:

USFHP ProAuth™ Referral
Entry Instructions (PDF)
Important notes regarding Prior Authorizations:
  • For both Generations Advantage and US Family Health Plan members, prior authorization may be requested by the member's PCP or by the servicing provider/facility.
  • Prior authorization is not required for emergency care.
  • Prior authorization requests should be submitted at least 14 calendar days prior to date of service or facility admission.

  • If the servicing provider is not part of the Martin’s Point network, we require a letter of medical necessity (including clinical documentation) explaining why the service(s) can only be provided by this specialist