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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.

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 services in 2021: For all lines of business except AdventHealth 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). For services in 2022: Small and Large Group commercial plans will continue to utilize Magellan Healthcare for behavioral health needs. For Medicare and Individual plans, behavioral health needs will be managed by Optum. Please visit the following sites for any authorization related needs through Optum: Individual plans Medicare plans

All Other Authorization Requests – We encourage participating providers to request authorization through the online provider portal located at myHFHP.org/4providers. 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.

Authorization List Documents:

2021

2022

Authorization Request Forms:

2021

Medicare Advantage, Individual and Family Plans and Small and Large Group Plans

2022

Medicare Advantage & Individual and Family Plans

Small and Large Group Plans

Formulary Prior Authorization Lists:

2021

2022


Last updated: 7/11/2022