Prior authorization

Determine if prior authorization is required

Use the tools below to determine if prior authorization is required for certain procedures, services or drugs.

For procedures or services
For drug coverage

Submit a prior authorization request

If prior authorization is required, submit a prior authorization request using the instructions below. Beginning March 1, 2024, all providers will be required to submit outpatient and inpatient authorization requests*, confirm authorization numbers and check the status of an authorization using the WellSense provider portal. Register for access here.

Type Instructions

Medical

Log in to our provider portal to submit your prior authorization request online.

Alternatively, you may fax a prior authorization form. This method will result in longer processing times.

*For New Hampshire providers, the primary method for submitting authorization requests will be the WellSense provider portal. For those providers who continue to submit prior authorization requests via fax, these requests are expected to experience longer processing times.
Pharmacy Prior authorization for medications
Behavioral health

Carelon Behavioral Health
Durable medical equipment

Check this document to confirm which provider types are managed by Northwood, Inc and which are managed by WellSense.
Radiology services

 eviCore healthcare

  • Phone: 888-693-3211, prompt #4 or 844-725-4448, prompt #1
  • Fax: 888-693-3210
Genetic testing

eviCore healthcare

  • Phone: 844-725-4448, prompt #2
  • Fax: 844-545-9213
Musculoskeletal services
(joint surgeries, spine surgeries, and interventional pain management treatments)

eviCore healthcare

  • Phone: 844-725-4448, prompt #3 (physical medicine)
  • Fax: 855-774-1319
Vision services

 Vision Services Plan (VSP)
Dental services

 DentaQuest

Appealing a prior authorization decision

If your prior authorization is denied, you or the member may request a member appeal. Use the Appeal Representative Authorization Form to get written permission from the member for you to appeal on their behalf.

For more information on the member appeal process, please reference the prior authorization denial letter or Section 10 of the Provider Manual: Appeals, Inquiries and Grievances.