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EXC - PRV - EPA Outage - temp
Please Note:
Learn how to use our new CareAdvance tool under the Request Authorization tab. Expand the appropriate service type category to locate our CareAdvance navigation guide, WebEx and tip sheet.
If you receive an email error message stating “You have no associated provider sets”, we can help you; please email your Web Username and Individual NPI to CAPAdministrator@excellus.com to update the system. At this time, there may be up to a two hour delay after receiving your information for the system update. Thank you for your patience as we make improvements.
If you have any questions, please contact your Provider Relations representative.
If you receive an email error message stating “You have no associated provider sets”, we can help you; please email your Web Username and Individual NPI to CAPAdministrator@excellus.com to update the system. At this time, there may be up to a two hour delay after receiving your information for the system update. Thank you for your patience as we make improvements.
If you have any questions, please contact your Provider Relations representative.
Page Title for page template
Prescription Drugs
Search for Required Medical Services-Request Authorization Page Tab Content
Nested Applications
Prescription Drugs Authorization Page Content
In order to help assure our members have access to safe, effective drug therapy and to protect against inappropriate use and waste, we require prior authorization and step therapy* on selected prescription medications.
Prior Authorization & Step Therapy Requirements
- Commercial 3-Tier Prior Authorization and Step Therapy Medication ListOpen a PDF
- Child Health Plus Prior Authorization and Step Therapy Medication ListOpen a PDF
- Medicaid Managed Care Prior Authorization and Step Therapy Medication ListOpen a PDF
- Specialty Rx Medication List (Self-Administered Drugs)Open a PDF
- Provider-Administered Medical Specialty Drugs Requiring Preauthorization - Commercial, Essential Plan, Exchange and Medicare Managed CareOpen a PDF
- Provider-Administered Medical Specialty Drugs Requiring Preauthorization - Medicaid Managed Care and Child Health PlusOpen a PDF
Request Approval Online with Electronic Prior Auth (ePA)
You and your staff can request a coverage determination electronically, directly from your electronic medical record (EMR) or through CoverMyMeds ePA Portal.
With ePA:
- You can submit requests for PA prospectively
- You can renew Prior Authorizations 60 days prior to expiration
- ePA through CoverMyMeds is free
- Any authorized personnel can use ePA
Request Approval by Fax or Eform
Prior Authorization Fax Request Forms
Send Coverage Determination Request via Secure Eform
* Step Therapy - In some cases, we require members to first try certain drugs to treat their medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat the medical condition, we may not cover Drug B unless the patient tries Drug A first. If Drug A does not work for the patient, we will then cover Drug B.
