Prior Authorizations

Certain services, items and prescriptions must be pre-approved.

Prior Authorization Code Lookup Tool

Use our online tool to discover which services, items and medications require prior authorization. 

Prior Authorizations Lookup Tool

Pharmacy
Prior Authorization Forms

Drugs listed on these pages require prior authorization from the Pharmacy department. Each drug will have a prior authorization form in PDF format that you can download and submit.

Medical
Prior Authorization Guidelines

These guidelines provide a list of all medical services requiring prior authorization. Lists for Medicare, Medicaid, CHIP and Individual and Family Plans identify which services require submission.

View the Medical Guidelines
Frequently Asked Questions

Jefferson Health Plans requires prior authorizations for select services performed in an outpatient setting, including those performed in the office, short procedure units, ambulatory surgery centers, clinics and hospital outpatient departments.

Click here to view administrative, authorization and maternity care forms. You can also place supply requests from this page.

More information about denials can be found in the provider manual.

For complete program details and eligibility criteria, please review the Medicare GLP-1 Bridge Demonstration FAQ document.