GLO-PRV-Authorization-Clear Coverage-Hide Clear Coverage app and remove links
Request Authorization
- Check the patient's benefits & coverage for plan-specific requirements.
- Submit your request below:
Safety Net:
Medicaid, Child Health Plus, Essential Plan
Safety Net:
Medicaid, Child Health Plus, Essential Plan
Online with eviCore healthcare
or call 1-866-889-8056
Note: Safety Net (excluding Essential) for MSK services only: call 1-800-363-4658
Commercial & Medicare:
Online with CareAdvance Provider
or call: 1-800-363-4658
- CareAdvance Inpatient Navigation GuideOpen a PDF
- CareAdvance Inpatient WebEx - 8.3MB
(click to download) - CareAdvance Outpatient Navigation GuideOpen a PDF
- CareAdvance Outpatient WebEx - 7.5MB
(click to download) - CareAdvance Tip SheetOpen a PDF
Once the preauthorization has been obtained, call Behavioral Health Utilization for the clinical review: 1-800-277-2138
Safety Net:
Medicaid, Child Health Plus, Essential Plan
Online with CareAdvance Provider
call: 1-844-694-6411, or Fax: 1-844-878-6989
- CareAdvance Inpatient Navigation GuideOpen a PDF
- CareAdvance Inpatient WebEx - 8.3MB
(click to download) - CareAdvance Outpatient Navigation GuideOpen a PDF
- CareAdvance Outpatient WebEx - 7.5MB
(click to download)
Medical Intake for Commercial and Medicare Products:
Call: 800-363-4658, or Fax: 877-203-9401
Safety Net Intake:
Call: 844-694-6411
Concurrent review can be submitted via SDS Provider Portal
- SDS Provider Portal
- SafetyNet Form for Inpatient Preauthorization RequestsOpen a PDF (Use Inpatient form for Observation Level of Service)
- SafetyNet Form for Outpatient Preauthorization RequestsOpen a PDF
Call 1-800-363-4658
Once the preauthorization has been created, the call will be transferred to SNF Utilization Management for Clinical Review
Safety Net:
Medicaid, Child Health Plus, Essential Plan
Call 1-844-694-6411 or Fax 1-855-742-0127
Long Term Care Support Services (LTSS):
Call 1-844-694-6411
Online with CareAdvance Provider
For Medical Specialty Drug Unit, call: 1-800-306-0151, or fax: 1-800-306-0188.
- Medical Specialty Drugs list (For Commercial, Exchange, Medicare, Essential Plan, Medicaid, Child Health Plus)- November 1, 2021Open a PDF
- Drug Prior Authorization Fax forms
- CareAdvance Outpatient Navigation GuideOpen a PDF
- CareAdvance Outpatient WebEx - 7.5MB
(click to download) - CareAdvance Inpatient Navigation GuideOpen a PDF
- CareAdvance Inpatient WebEx - 8.3MB
(click to download) - CareAdvance Tip SheetOpen a PDF
Medicaid, Child Health Plus, Essential Plan
Online with CareAdvance Provider
or call 1-800-306-0151 or fax: 1-800-306-0188.
- Medical Specialty Drugs list (For Commercial, Exchange, Medicare, Essential Plan, Medicaid, Child Health Plus)- November 1, 2021Open a PDF
- Medicaid Managed Care-Medical Specialty Drugs (Health Professional Administered) Standard Authorization FormOpen a PDF
- CareAdvance Outpatient Navigation GuideOpen a PDF
- CareAdvance Outpatient WebEx - 7.5MB
(click to download) - CareAdvance Inpatient Navigation GuideOpen a PDF
- CareAdvance Inpatient WebEx - 8.3MB
(click to download) - CareAdvance Tip SheetOpen a PDF
Online through CoverMyMeds ePA Portal
Fax: Prior Authorization Fax Request Forms
Eform: Send Request via Secure Eform (sends to our FAX server)
Or, call the number on the Member's ID Card
New to CareAdvance Provider?
CareAdvance Training Materials
For questions, please contact your Provider Relations Representative
Get Your Facets Provider ID
You'll need your Facets ID to use CareAdvance Provider.
eviCore Healthcare Information
Get help with urgent/emergency requests, appeals process and help acessing eviCore online.
Learn more
Modal for Get Your Facets Provider ID
Get Your Facets Provider ID
To recieve your Facets Provider ID you can either
- Call: 1-800-363-4658 or
- You can Email our Provider Help Desk
Modal for Behavioral Health Fax and Request Forms
Behavioral Health Fax and Request Forms
- SafetyNet Fax Form for Inpatient Preauthorization RequestsOpen a PDF
- SafetyNet Fax Form for Outpatient Preauthorization RequestsOpen a PDF
- NeuroPsychological Testing Authorization Request FormOpen a PDF
Please use this form for Medicaid Managed Care and HARP (Blue Option Plus & Premier Option Plus) lines of business only - Outpatient Treatment Authorization Request FormOpen a PDF
- Adult Behavioral Health Home and Community Based Services (BH HCBS): Prior and/or Continuing Authorization Request FormOpen a PDF
Please include a completed HCBS Authorization Checklist along with the HCBS Prior and/or Continuing Authorization request form - HCBS Auth ChecklistOpen a PDF
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