Coverage Information

Call Your PCP When You Need Regular Care.

He or she will send you to see a specialist for tests, specialty care and other covered services that he or she doesn't provide. Be sure your PCP approves you to see a specialist. We will cover this care. If your PCP does not provide an approved service, ask him or her how you can get it.

Prior Authorization

Prior authorization (or PA for short) means we must approve a service or prescription drug before you can get it. You or your PCP/specialist should contact us to ask for this approval. If we do not approve your request, we'll let you know. Plus, we’ll give you details about how to file an appeal. See your member handbook for the list of services that are covered, and which require a PA.

How to Get an Authorization

Getting Authorization
Available Services Without Prior Authorization

Getting Authorization

Type of Request	Decision Time Frame	Who Can Request One	How to Request
Normal (for non- emergency care)	Seven calendar days	You or your provider	Call: 1-866-334-7927 (TTY 711) Fax: 1-877-297-3112
Expedited/Fast** (for urgent care)	48 hours	You, your provider	Call: 1-866-334-7927 (TTY 711) Fax:1-877-297-3112 Say: ‘I’d like an expedited/fast decision”

*Sometimes we may need more time to make a standard decision. This may be because we need more information and it’s in your best interest. If so, we’ll take up to seven more calendar days.

**Sometimes we may need more time to make a fast decision. If so, we’ll take up to two more business days.

Available Services Without Auth

You do not need approval from us or your PCP for the following services:

Chiropractic
Dermatology
Emergency/urgent care
Family planning from any participating Medicaid provider
One women’s health visit to an OB/GYN provider each year
Podiatry
Post-stabilization care

Even though you do not need approval for these services, you will need to pick a network provider. Look through your provider directory to find one.

Don’t forget about our online provider search tool – Find a Provider. When you’ve made your choice, call to set up an appointment. Remember to take your ID card with you.

Getting Authorization

Type of Request	Decision Time Frame	Who Can Request One	How to Request
Normal (for non- emergency care)	Seven calendar days	You or your provider	Call: 1-866-334-7927 (TTY 711) Fax: 1-877-297-3112
Expedited/Fast** (for urgent care)	48 hours	You, your provider	Call: 1-866-334-7927 (TTY 711) Fax:1-877-297-3112 Say: ‘I’d like an expedited/fast decision”

*Sometimes we may need more time to make a standard decision. This may be because we need more information and it’s in your best interest. If so, we’ll take up to seven more calendar days.

**Sometimes we may need more time to make a fast decision. If so, we’ll take up to two more business days.

Available Services Without Prior Authorization
Available Services Without Auth

You do not need approval from us or your PCP for the following services:
- Chiropractic
- Dermatology
- Emergency/urgent care
- Family planning from any participating Medicaid provider
- One women’s health visit to an OB/GYN provider each year
- Podiatry
- Post-stabilization care
Even though you do not need approval for these services, you will need to pick a network provider. Look through your provider directory to find one.

Don’t forget about our online provider search tool – Find a Provider. When you’ve made your choice, call to set up an appointment. Remember to take your ID card with you.