Pre-Authorization for all services is managed by Optima Health Clinical Care Services. All reviews and determinations are based on medical necessity as supported by sound medical criteria and standards of care.
Medical and behavioral health services requiring pre-authorization should be submitted on the appropriate form from the list below. Each form has a dedicated fax number for efficient and timely processing.
Behavioral Health Authorizations
Elective admissions/requests should be submitted for pre-authorization as soon as possible or at least 7-10 days prior to scheduling an admission or procedure.
For urgent and emergent pre-authorizations, call Clinical Care Services at 1-800-229-5522, option 0.
Authorization status is available by signing into Provider Connection or by calling Provider Services. Providers are also are notified of all authorization decisions in writing (by fax). Elective decisions are typically rendered within 4-5 days from receipt of all requested information. Urgent cases will be completed within 72 hours.
Emergency requests due to life-altering situations will be completed within 24-48 hours.