Health Plan Pre-Service Information

The Pre-Service Directory has been discontinued effective July 25, 2020 due to low utilization. Some of the health plans' pre-service information is provided below as a quick reference. If you have specific pre-service questions, please work directly with the health plans.

1. Medical Policy/Guideline Update List by Health Plan
2. Pre-Service Links by Health Plan

Health Plan	Pre-Service Link	Comment - Other Related URLs
Amerigroup - DSNP	https://providers.amerigroup.com/Pages/PLUTO.aspx
CHPW - Medicare Advantage	https://medicare.chpw.org/provider-center/prior-authorization/
Cigna
Coordinated Care - Ambetter	https://www.coordinatedcarehealth.com/providers/preauth-check/ambetter-pre-auth.html
First Choice Health (TPA and PPO)	https://www.fchn.com/Providers
HCA Apple Health - Medicaid FFS	https://www.hca.wa.gov/billers-providers-partners/prior-authorization-claims-and-billing/prior-authorization-pa	Provider Billing Guides & Fee Schedules: https://www.hca.wa.gov/billers-providers-partners/prior-authorization-claims-and-billing/provider-billing-guides-and-fee-schedules#prior-authorization
HCA Apple Health - Amerigroup	https://providers.amerigroup.com/Pages/PLUTO.aspx
HCA Apple Health - CHPW	https://www.chpw.org/for-providers/prior-authorization-and-medical-review/
HCA Apple Health - Coordinated Care	https://www.coordinatedcarehealth.com/providers/preauth-check/medicaid-pre-auth.html
HCA Apple Health - Molina	https://provider.molinahealthcare.com/	Log in to OHP Click on Molina Healthcare Logo On the WebPortal Main Page click on Forms Scroll down to Prior Authorization by CPT code Guide. Be sure to select the guide that coincides with the date of service you are looking up. Be sure to review the column appropriate to the coverage plan - Medicaid, Medicare or Marketplace.
HCA Apple Health - UHC Community Plan	https://www.uhcprovider.com/en/prior-auth-advance-notification.html
Kaiser Permanente Oregon and Southwest Washington	https://extsso.kp.org/kpsso-ap/signIn.html or OneHealthPort Single-Sign On	Select the Utilization Management dropdown menu
Kaiser Permanente  Washington	https://wa-provider.kaiserpermanente.org/clinical-review	https://wa-provider.kaiserpermanente.org/provider-manual/index Scroll down to Referrals and Clinical Review
Labor & Industries	https://lni.wa.gov/patient-care/authorizations-referrals/authorization/	For Payment Policies:   https://lni.wa.gov/patient-care/billing-payments/fee-schedules-and-payment-policies/
Molina - Marketplace	https://provider.molinahealthcare.com/	Log in to OHP Click on Molina Healthcare Logo On the WebPortal Main Page click on Forms Scroll down to Prior Authorization by CPT code Guide. Be sure to select the guide that coincides with the date of service you are looking up. Be sure to review the column appropriate to the coverage plan - Medicaid, Medicare or Marketplace.
Premera Blue Cross	https://www.premera.com/wa/provider/utilization-review/about-prior-authorization/
Providence Health Plans	https://phpprovider.providence.org/portal/	Click on Authorization Codes for ‘Combined Prior Authorization List’
Regence	https://www.regence.com/provider/pre-authorization/commercial
UHC - Commercial	https://www.uhcprovider.com/en/prior-auth-advance-notification.html