Utilization Management

Preauthorization and Predetermination

This page provides the tools you need to help you determine coverage through preauthorization, predetermination and post-service reviews.

Eligibility and Benefits Reminder:

Check eligibility and benefits first to confirm membership, check coverage, determine if you are in-network for the member’s policy and determine whether preauthorization is required through Availity® Learn more about third-party links or your preferred vendor.

Utilization Management

Utilization management is at the heart of how we help members access the right care, at the right place and at the right time. Learn about the types of utilization management reviews – preauthorization, predetermination and post-service review. Learn More

How to Request Preauthorization or Predetermination

Review the process to submit requests for preauthorization and predetermination. Learn More

Preauthorization Lists

Refer to the lists of services or drug codes that may require preauthorization. Learn More