Requesting Authorization

Information for Requesting Authorizations    

For some medical services, PCPs and Providers must request referrals and prior authorizations on behalf of Members. Specialists should submit requests for further care after the initial visit. In Tier 1, these requirements are minimal when Members receive care from Prime Providers and Facilities.

When authorizations are required, they must be approved by Prime Utilization Management before Members receive care. Prime has made these approvals faster and easier than ever.

Through our online Prime Authorization System (PAS), 60 percent of requests are approved instantly. 96 to 98 percent are approved overall with 92 percent approved within 24 hours.

If you don’t already have PAS access and want to request prior authorization via fax, please click here to download the form. To request a PAS application login, email EHP@Primehealthcare.com with your group name and tax ID.

We also added a long list of Auto-Approved services that are covered automatically without prior authorization. To download and review the most recent Authorization Process (effective 4/1/2022), including the list of Auto-Approved services, click here.

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