Providers: Authorizations

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.

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).

Specialty Imaging, Echocardiograms, High-tech Imaging, Genetic Laboratory testing, Sleep Studies and Positive Airway Pressure (PAP) Devices - Authorizations are processed by eviCore Healthcare. Submit requests to eviCore through their website at: evicore.com

All Other Authorization Requests – We encourage participating providers to request authorization through the online provider portal located at hfprovider.healthtrioconnect.com. For certain services requested via the online portal, you will have an option to complete a questionnaire. The answers to this questionnaire may lead to an automatic approval. However, even if an automatic approval is not provided immediately, the information provided via the questionnaire will help Health First Health Plans reduce the review turnaround time. If you are a non–participating provider or encounter issues submitting via the online provider portal, please fax your authorization request to 1.855.328.0059 (toll-free) or 321.434.4271 (local). For additional assistance you may also call Customer Service toll-free at 1.844.522.5282.

Authorization List Documents:

• Medical Drug Authorization List - Reference list of codes for injectable and infusible medications
• eviCore Medical Oncology Drug Authorization List - Items that require pre-certification
• Medical Prior Authorization List - Items and services that require pre-certification
• Medical Prior Authorization List Changes - Requirements that have changed since the last update

Authorization Request Forms:

2021

• Provider Prior Authorization Request Form
• Provider Request for Medicare Prescription Drug Coverage Determination
• Provider Request for Commercial Prescription Drug Coverage Determination
• Hospice Pharmacy Authorization Request Form

2022

• Provider Prior Authorization Request Form
• Provider Dispute Form

Formulary Prior Authorization Lists:

2021

• (MA-PD): Prior Authorization | Step Therapy Criteria
• (MA-PD Employer Groups): Prior Authorization | Step Therapy Criteria
• Commercial Metal 5T Formulary: Prior Authorization | Step Therapy
• Commercial 5T Formulary: Prior Authorization | Step Therapy
• Commercial 3T Formulary: Prior Authorization | Step Therapy

2022 - Coming Soon

Last updated: 10/15/2021