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You Can Now Print Your Referrals & Authorizations

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

Information relating to referrals and authorizations of care.

Referral and authorization information for treatments including prescriptions, step therapy, mental health treatment, and more.

For a list of medical items and services that require prior authorization, decision timeframes, and other associated data, please refer to our Prior Authorization Metrics page.


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Questions?

Refer to the Provider Manual for information on key topics:

Authorization Requirement Information and Codes

New Requirements | Cardiac

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 Requirements | Non-Cardiac

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

 

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

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
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