Requesting Authorization

Information for Requesting Authorizations    

For medical services, PCPs (Primary care Providers) and Specialists must request referrals and prior authorizations on behalf of Members.

In Tier 1, these requirements are minimal when Members receive care from Prime Providers and Facilities and they can utilize our online portal – Prime Authorization System (PAS), where 60 percent of requests are approved instantly. 96 to 98 percent are approved overall with 92 percent approved within 24 hours.

When certain services need to be rendered for Prime Healthcare EPO or Value Plan members they must be reviewed and approved by Prime Utilization Management before Members receive care. Prime has made these approvals faster and easier than ever.

Authorization turnaround time details:

Routine/ Standard: within 7-10 Business days

Urgent/Stat: within 72 business hours

Retro: within 30 business days

Providers can submit prior authorization requests via:

Fax: 909-235-4414 (or) 844-308-7505

Tier1 Providers – Portal: Provider Authorization Portal (registration is required)

Prior authorization resources:

• • Overview of services requiring authorization
  • Preventive screening services code list 
  • Tier1 – Services Not requiring Prior Authorization 
  • How to obtain a prior authorization
  • Prior authorization request form
    • • Prime Obstructive Sleep Apnea-Intake form

Need Help?

We are here for you! If you have any questions, please contact our support team on 877-234-5227.