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Commercial Pre-Authorization

Vision Services are handled by EyeMed.

High Tech Imaging Services, Orthopedic and Spine surgeries are handled by Evolent.

Behavioral Health Services are handled by MHN through December 31, 2023.
Note: Please visit our Behavioral Health Services Transition webpage for information about Behavioral Health Services administration effective January 1, 2024.

Chiropractic Services are handled by ASH.

Radiology Services are handled by NCH.

 

Prior Authorization Requirements (PDF)
Medical Injectable Prior Authorization Requirements (PDF)
Request for Commercial Inpatient Prior Authorization Form (PDF)
Request for Commercial Outpatient Prior Authorization Request Form (PDF)