Prior Authorization

  • For prescriptions, please visit our Pharmacy page.
  • For mental health/substance abuse services 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 theForms and Documents section for more information.

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