Prior Authorization

Determine if prior authorization is required

Use the tools below to determine if prior authorization is required for certain procedures, services or drugs.

For procedures or services

Submit a prior authorization request

If prior authorization is required, submit a prior authorization request using the instructions below.

Type Instructions


Log in to our provider portal to submit your prior authorization request online.

Alternatively, you may fax a prior authorization form. This method will result in longer processing times.

Pharmacy Prior authorization for medications

Behavioral health

Carelon Behavioral Health

Durable medical equipment

 Check this document to confirm which provider types are managed by Northwood, Inc and which are managed by WellSense.

Outpatient radiology

 eviCore healthcare

  • Radiology/Cardiology: 888-693-3211, Prompt #4; 844-725-4448, Prompt #1; Fax: 888-693-3210
  • Genetic Testing (Lab Management): 844-725-4448, Prompt #2; Fax: 844-545-9213
  • MSK-Spine, Joint, Pain: 844-725-4448, Prompt #3 Physical Medicine; Fax: 855-774-1319
Vision services

 Vision Services Plan (VSP)

Dental services


Appealing a prior authorization decision

If your prior authorization is denied, you or the member may request a member appeal. Use the Appeal Representative Authorization Form to get written permission from the member for you to appeal on their behalf.

For more information on the member appeal process, please reference the prior authorization denial letter or Section 10 of the Provider Manual: Appeals, Inquiries and Grievances.