You can now print your referrals and 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.
Authorizations and Referrals
Reminder: Effective July 1, 2024 prior authorization for the following PET and SPECT imaging services will be required for Generations Advantage and USHFP members
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 will be open to receive requests for these services on Monday, June 17th.
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)
Authorization Instructions
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
USFHP Referral Instructions
ACTIVE STARTING 10/1
As a TRICARE Prime® plan, US Family Health Plan members are required by TRICARE® to receive a referral from their PCP before seeing any other provider or specialist (exceptions include, but not limited to, allowance for self-referral for preventive and emergency care).
Effective October 1, 2023 and pursuant to new TRICARE reporting requirements, the Martin’s Point US Family Health Plan will require that referrals to other providers or specialists be submitted to the health plan. Specialists who are referring to another specialist will be required to submit a referral.
For more information, see the US Family Health Plan referral process FAQs.