Prior Authorization

  • For prescriptions, please visit our Pharmacy page.
  • For mental health/substance abuse services for Generations Advantage Plan members call BHCP at 1-800-708-4532.
  • For mental health/substance abuse services for US Family Health Plan members call BHCP at 1-888-812-7335.
  • 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 the 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.
  • Imaging Services: The following changes to authorization requirements for imaging services will be effective for dates of service on or after October 1, 2020.
    • Authorization will no longer be required for :
      • Cardiac ECHO, Cardiac Nuclear Stress test and Ultrasound
    • Martin’s Point will assume managing authorization for:
      • Cardiac CT, Cardiac MRI and Cardiac PET
    • eviCore will continue to manage authorizations for:
      • Advanced imaging (non Cardiac CT, MRI, PET, Nuclear

Retrospective Authorization

Please refer to the Forms and Documents section for more information.

Questions? Read more in the Provider Manual or Contact Us.