Prior authorization lookup tool

 

Use this tool for determining what outpatient services require prior authorization.

Please note

 

  1. This tool is for outpatient services only.
  2. Inpatient services and nonparticipating providers always require prior authorization.
  3. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all noncovered services (for example, experimental procedures, cosmetic surgery) — Refer to your provider manual for coverage/limitations.

 

* Services may be listed as requiring precertification that may not be covered benefits for a particular member. Please verify benefit coverage prior to rendering services.

Availity Essentials applications

Verify member eligibility or benefits

  • Log in to Availity Essentials, or
  • Use the Prior Authorization application within Availity, or
  • Call Provider Services — available Monday through Friday, 8 a.m. to 6 p.m., or
  • After hours, call the 24/7 Nurse HelpLine

 

Call Provider Services:  800-782-0095

 

Call Nurse HelpLine:  888-850-1108

Submit a prior authorization request

 

  1. Log in to Availity Essentials.
  2. Select Patient Registration from the top navigation.
  3. Then, select Auth/Referral Inquiry or Authorizations.

Interested in becoming a provider in the Wellpoint network?

 

We look forward to working with you to provide quality service for our members.

 

Join our network