Prior Authorization Look-up Tool

A new Prior Authorization Lookup Tool is now available on our website. This resource helps providers and staff quickly identify whether prior authorization is required for select services before care is rendered.

Users can search by CPT or HCPCS code and view general prior authorization information by line of business.

How to access the tool:

Please note that the lookup tool is for general guidance only. Providers are responsible for verifying member eligibility, benefits, and detailed authorization requirements before rendering services, as requirements may vary by plan, place of service, provider status, diagnosis, benefit coverage, and other criteria.

If prior authorization is required, please follow the applicable submission process as outlined in our provider manual and include all required clinical documentation to support timely review.

If you have questions or need assistance, please contact the Jefferson Health Plans Utilization Management department at 1-866-500-4571.