Prior Authorization Lookup Tool
Please verify benefit coverage prior to rendering services. Inpatient services and non-participating providers always require prior authorization.
Please note:
- This tool is for outpatient services only.
- Inpatient services and non-participating providers always require prior authorization.
- This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all non-covered services (i.e., experimental procedures, cosmetic surgery, etc.) — refer to your provider manual for coverage/limitations.
* Services may be listed as requiring prior authorization that may not be covered benefits for a particular member. Please verify benefit coverage prior to rendering services.
To determine coverage of a particular service or procedure for a specific member:
- Access eligibility and benefits information on the Availity Web Portal* or
- Use the Prior Authorization tool within Availity or
- Call Provider Services at 1-800-450-8753 (TTY 711)
- After hours, verify member eligibility by calling the 24/7 NurseLine at 1-800-300-8181
To request authorizations:
- From the Availity home page, select Patient Registration from the top navigation.
- Select Auth/Referral Inquiry or Authorizations.
* Availity, LLC is an independent company providing administrative support services on behalf of Empire BlueCross BlueShield HealthPlus.