Prior authorization requirements
Determine how to submit authorization requests and what services require prior authorization.
Interactive Care Reviewer (ICR) requests
Effective July 1, 2024, all authorization requests for Wellpoint must be submitted through Interactive Care Reviewer (ICR) found within the Availity Essentials platform. ICR is available 24 hours a day, 7 days a week to accept prior authorization requests.
To request or check the status of a prior authorization request or decision for a particular plan member, access our ICR tool via Availity Essentials. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate.
Don't have an Availity account?
Helpful contact information for prior authorization requests
Utilization Management (UM) department
Our UM department is available via phone Monday through Friday, 8:00 a.m. to 5:00 p.m.
Call: 1-866-655-7423
Preservice review fax: 1-855-402-6983
Current inpatient review fax: 1-855-402-6985
Behavioral health inpatient fax: 1-855-325-5556
Behavioral health outpatient fax: 1-855-325-5557
Behavioral health
Services billed with the following revenue codes always require prior authorization:
0240-0249 — all-inclusive ancillary psychiatric
0901, 0905-0907, 0913, 0917 — behavioral health treatment services
0944-0945 — other therapeutic services
0961 — psychiatric professional fees
You may fax all requests for services that require prior authorization to:
Behavioral health inpatient fax: 1-855-325-5556
Behavioral health outpatient fax: 1-855-325-5557
Pharmacy
Services billed with the following revenue codes always require prior authorization:
0632 — pharmacy multiple sources
Call: 1-888-483-0801
Fax: 1-800-531-7787
Emergency medical services
Wellpoint does not require prior authorization for treatment of emergency medical conditions. In the event of an emergency, members may access emergency services 24/7. If emergency services result in the member’s admission to the hospital, providers must contact Wellpoint the next business day following admission. Wellpoint is available via fax at 1-855-402-6985 or ICR via Availity Essentials 24 hours a day, 7 days a week to accept emergent admission notifications.
Emergent admission notification fax: 1-855-402-6985
Elective services
Elective services provided by or arranged at nonparticipating facilities always require prior authorization.
Need more assistance with authorization?
Check out our Prior authorization lookup tool to determine prior authorization requirements or contact Provider Services for assistance. You may also find information related to services requiring prior authorization in your provider manual.
Related information
Prior authorization lookup tool
Drug requirements and reviews
For Substance Use Disorder (SUD) Providers: Prior Authorization and Billing Update
Mandated Sovaldi Patient Consent Form: Include with Sovaldi Prior Authorization Request
Prior Authorization Requirements for Paravertebral Facet Injection
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