The medical necessity of certain services must be established through a prior or pre-authorization process before they can be performed. Please refer to AHIN or the member’s benefit certificate to determine which services need pre-authorization. Prior authorization requests will be reviewed by the Prior Authorization Team based on medical guidelines from USAble Mutual.

What to include with the completed Prior Authorization form [pdf, 80 KB]

• Requested service(s)
• Name and telephone number of contact person
• Fax number to send determination
• Requesting / Performing Provider’s NPI or Provider ID
• Copy of member’s insurance card (front/back)
• CPT Code(s) and/or HCPCS Code(s)
• Medical records to support requested services