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Prior Authorization Guide

How to Secure Prior Authorization

How to Secure Prior Authorization

Pre-Auth Needed Tool

Use the Pre-Auth Needed Tool  to quickly determine if a service or procedure requires prior authorization.

Submit Prior Authorization

If a service requires authorization, submit via one of the following ways:


ELECTRONIC SUBMISSION METHODS
Secure Provider Portal
Availity Essentials
These are the preferred and fastest method.


PHONE
1-833-552-3876
After normal business hours and on holidays, calls are directed to the plan’s 24-hour nurse advice line. Notification of authorization will be returned by phone, fax or web.

FAX
Submit using the CCH Standard Plan Prior Authorization Fax Form (PDF) and submit to the appropriate fax line according to service type. Fax numbers can be found on the form.

When submitting authorization requests, it is critical to include phone or fax numbers. Requests for Information (RFIs) can only be conducted via phone or fax. Approval/denial letters are also sent via fax. 

See below for a list of services that require prior authorization.

Please note:

  1. Emergency/urgent services DO NOT require prior authorization.
  2. All out-of-network services and providers DO require prior authorization.
  3. Failure to complete the required authorization or notification may result in a denied claim.

Services and Procedures Requiring Prior Authorization

THE FOLLOWING LIST IS NOT ALL-INCLUSIVE

Ancillary Services

  • Air Ambulance Transport (non-emergent fixed wing airplane)
  • Home healthcare services including home hospice, home infusion, skilled nursing, personal care services, and therapy
  • Orthotics/Prosthetics billed with an “L” code costing $500 or more or rental of $250 or more
  • Hearing Aid devices including cochlear implants
  • Genetic Testing

Procedures/Services

  • All elective/scheduled admissions at least 5 business days prior to the scheduled date of admit (including deliveries) Note: Normal newborns do not require an authorization unless the level of care changes or the length of stay is greaterthan normal newborn
  • All services performed in out of network facility
  • Hospice care
  • Rehabilitation facilities
  • Skilled nursing facility
  • Transplant related support services including pre-surgery assessment and post-transplant follow up care 
  • Notification for all Urgent/Emergent Admissions: Within one (1) business day following date of Admission Newborn Deliveries must include birth outcomes

Inpatient Admissions

  • All procedures and services performed by out-of-network providers (except ER,urgent care, family planning, and treatment of communicable disease)
  • Hysterectomy
  • Oral Surgery
  • Pain Management
  • Potentially Cosmetic including but not limited to: 
    • bariatric surgery, blepharoplasty, mammoplasty, otoplasty, rhinoplasty, septoplasty, varicose vein procedures
    • Experimental or investigational
    • High Tech Imaging (i.e. CT, MRI, PET)
Page Last Updated: 07/24/2025