Manage medical and drug authorizations
Some medical services, procedures, durable medical equipment (DME) and drugs require approval before they can be covered by your patients' benefits.
Upon receiving approval, you will be given an authorization number. Please reference this number on all claims related to the specific procedure or service requiring prior approval. Also, remember that services determined as not medically necessary, investigational, or experimental are the liability of the provider.
Step 1 — Verify if authorization is required.
Use the medical authorization table (procedures, imaging and DME) or drug prior authorization list (medications and drugs) to determine if you need an authorization. Also view authorizations for out-of-area members.
User guides & resources
JivaTMMedical Authorization user guide (Jiva) Secure Site
Jiva quick guide for submitting inpatient (IP) requests Secure Site
Jiva quick guide for submitting outpatient (OP) requests Secure Site
Jiva quick guide for submitting out of network (OON) requests Secure Site
Jiva quick guide for submitting extending stay or service requests Secure Site
InterQual® clinical review training video Secure Site
Novologix®Drug Authorization User Guide (Novologix) PDF File
Novologix training video
Imaging Services Pre-Authorization Code Groupings Secure Site
Types of Authorizations
InterQual® Criteria and SmartSheetsTM
Medical policies A-Z and medical policy overview
Prior Approval for Federal Employee Program (FEP) Members
Radiology pre-authorization requests Q&A Secure Site
SmartSheetsTM Secure Site
Utilization management-related webinars Secure Site