Certain items and services require prior authorization (pre-certification) to evaluate medical necessity and eligibility for coverage. See the current Authorization List to determine if prior authorization is required for general categories of services. See the Authorization List Code Reference companion document for details.
We use both internal and external resources in the authorization process. For the services listed below, the process is handled by the organizations indicated.
Specialty Imaging, Echocardiograms, Sleep Studies and Positive Airway Pressure (PAP) Devices – Authorizations are processed by AIM Specialty Health (AIM). Submit requests to AIM or access clinical guidelines through their website at: aimspecialtyhealth.com
Spinal Procedures (surgeries, injections) – Effective 5/1/17, authorizations are processed by Palladian Health.
Behavioral Health – For all lines of business except Florida Hospital and Rosen TPA plans, authorizations are processed by Magellan Healthcare. Submit requests to Magellan through their website at: magellanprovider.com or by calling 1.800.424.HFHP (4347).
All Other Authorization Requests - Submit to Health First Health Plans by faxing 1.855.328.0059.
Authorization List Documents:
Authorization Request Forms:
Other clinical guidelines are available through organizations responsible for administering the authorization process.
Last updated: 4/7/2017