Authorization Guidelines

Summary of services that require prior authorization

Download a copy of the 2020 Authorization Guidelines.

Obtaining prior authorization is the responsibility of the PCP or treating provider.  Members who need prior authorization should work with their provider to submit the required clinical data.

Submit the request in one of the following ways:

  • via fax to 410-779-9336 or 443-552-7407/7408
  • via telephone at 800-730-8543 / 410-779-9359.

Click here to download a copy of our preauthorization request forms. 

Important Information

  • The Authorization Guidelines document is not all inclusive.
  • All inpatient services require authorizations.
  • All outpatient services in the below categories and/or outpatient services and procedures by a non-par facility or non-par provider require an authorization.
  • Authorization is not a guarantee of payment.
  • All authorizations are subject to eligibility requirements and benefit plan limitations.
  • Authorizations are issued for medical services and assumes that providers submit claims with codes billable under the current Medicaid Fee Schedule contact Provider Relations with questions.
  • Verification of eligibility and/or benefit information is not a guarantee of payment.
  • Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility, any claims received during the interim period and the terms of coverage applicable on the date services were rendered.