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Health Plan Pre-Service Information

The Pre-Service Directory has been discontinued effective July 25, 2020 due to low utilization. Some of the health plans’ pre-service information is provided below as a quick reference. If you have specific pre-service questions, please work directly with the health plans.

 

Health Plan Pre-Service Link Comment – Other Related URLs
Amerigroup – DSNP https://providers.amerigroup.com/Pages/PLUTO.aspx
CHPW – Medicare Advantage https://medicare.chpw.org/provider-center/prior-authorization/
Coordinated Care – Ambetter https://www.coordinatedcarehealth.com/providers/preauth-check/ambetter-pre-auth.html
First Choice Health (TPA and PPO) https://www.fchn.com/Providers
HCA Apple Health – Medicaid FFS https://www.hca.wa.gov/billers-providers-partners/prior-authorization-claims-and-billing/prior-authorization-pa Provider Billing Guides & Fee Schedules
HCA Apple Health – Amerigroup https://providers.amerigroup.com/Pages/PLUTO.aspx
HCA Apple Health – CHPW https://www.chpw.org/for-providers/prior-authorization-and-medical-review/
HCA Apple Health – Coordinated Care https://www.coordinatedcarehealth.com/providers/preauth-check/medicaid-pre-auth.html
HCA Apple Health – Molina https://provider.molinahealthcare.com/
  • Log in to OHP
  • Click on Molina Healthcare Logo
  • On the WebPortal Main Page click on Forms
  • Scroll down to Prior Authorization by CPT code Guide. Be sure to select the guide that coincides with the date of service you are looking up. Be sure to review the column appropriate to the coverage plan – Medicaid, Medicare or Marketplace.
HCA Apple Health – UHC Community Plan https://www.uhcprovider.com/en/prior-auth-advance-notification.html
Kaiser Permanente Oregon and Southwest Washington https://extsso.kp.org/kpsso-ap/signIn.html
Kaiser Permanente Washington https://wa-provider.kaiserpermanente.org/clinical-review https://wa-provider.kaiserpermanente.org/provider-manual/index
Labor & Industries https://lni.wa.gov/patient-care/authorizations-referrals/authorization/ https://lni.wa.gov/patient-care/billing-payments/fee-schedules-and-payment-policies/
Molina – Marketplace https://provider.molinahealthcare.com/
  • Log in to OHP
  • Click on Molina Healthcare Logo
  • On the WebPortal Main Page click on Forms
  • Scroll down to Prior Authorization by CPT code Guide. Be sure to select the guide that coincides with the date of service you are looking up. Be sure to review the column appropriate to the coverage plan – Medicaid, Medicare or Marketplace.
Premera Blue Cross https://www.premera.com/wa/provider/utilization-review/about-prior-authorization/
Providence Health Plans https://phpprovider.providence.org/portal/ Click on Authorization Codes for ‘Combined Prior Authorization List’
Regence https://www.regence.com/provider/pre-authorization/commercial
UHC – Commercial https://www.uhcprovider.com/en/prior-auth-advance-notification.html

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