Prior authorization requirements and payer lookup

An authorization answer is not a coverage, eligibility, or payment answer. Substrate does not submit prior authorization requests.

What prior authorization means

Prior authorization, preauthorization, and precertification are names for the payer process in the HealthCare.gov glossary. Notification is a different label.

A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost.

HealthCare.gov preauthorization glossary

The glossary states why a plan asks for that decision. It also says the decision is not a promise the plan will cover the cost.

Prior authorization lookup

The first step is choosing a payer. This finder lists only guides that are published. Other payers stay on their directory profiles until a guide is published.

Anthem routing

Anthem prior authorization depends on the state and product. This finder does not publish an Anthem guide. Open the regional plan from payer lookup and use that plan’s official list.

Blue Cross Blue Shield routing

Blue Cross and Blue Shield prior authorization is plan-specific. Use payer lookup for the regional profile. One official routing page is Blue Cross and Blue Shield of Illinois utilization management.

Blue Cross and Blue Shield of Illinois utilization management

Published resources

Aetna prior authorization CPT list
Substrate guide
UnitedHealthcare prior authorization CPT list
Substrate guide
Humana prior authorization CPT list
Substrate guide
Cigna prior authorization CPT list
Substrate guide
Anthem Blue Cross Blue Shield of California prior authorization CPT list
Substrate guide
Anthem Blue Cross Blue Shield of Colorado prior authorization CPT list
Substrate guide
Anthem Blue Cross Blue Shield of Georgia prior authorization CPT list
Substrate guide
Anthem Blue Cross and Blue Shield New Hampshire prior authorization CPT list
Substrate guide
Anthem Blue Cross and Blue Shield Nevada prior authorization CPT list
Substrate guide
Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list
Substrate guide
Blue Cross Blue Shield Oklahoma prior authorization CPT list
Substrate guide
Blue Cross and Blue Shield of Montana prior authorization CPT list
Substrate guide
Blue Shield of California Promise Health Plan prior authorization CPT list
Substrate guide
Blue Shield of California prior authorization CPT list
Substrate guide
Peach State Health Plan prior authorization CPT list
Substrate guide
Premera Blue Cross of Washington prior authorization CPT list
Substrate guide
Regence BlueCross BlueShield of Oregon prior authorization CPT list
Substrate guide
Regence BlueCross BlueShield of Utah prior authorization CPT list
Substrate guide
Regence BlueShield of Idaho prior authorization CPT list
Substrate guide
Regence BlueShield of Washington prior authorization CPT list
Substrate guide
Predetermination vs prior authorization
Substrate guide
Prior authorization for MRI
Substrate guide
Prior authorization process and submission checklist
Substrate guide
Aetna precertification lists
Official source
Aetna participating provider precertification list
Official source
Aetna health care professional forms
Official source
HealthCare.gov preauthorization glossary
Official source
Blue Cross and Blue Shield of Illinois utilization management
Official source