This page includes the previous prior authorization summaries and code list documents that were posted at the end of the year.
- 2024 Prior Authorization Requirements - Summary of Services
- 2024 Commercial Outpatient Benefit Prior Authorization Behavorial Health Procedure Code List
- 2024 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes
- 2024 Commercial Outpatient Benefit Prior Authorization Fully Insured Medical Surgical Procedure Code List
- 2024 Commercial Specialty Pharmacy Prior Authorization Drug List
- 2023 Prior Authorization Requirements - Summary of Services
- 2023 Commercial Outpatient Benefit Prior Authorization Behavorial Health Procedure Code List
- 2023 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes
- 2023 Commercial Outpatient Benefit Prior Authorization Fully Insured Medical Surgical Procedure Code List
- 2023 Commercial Specialty Pharmacy Prior Authorization Drug List
- 2022 Prior Authorization Requirements - Summary of Services
- 2022 Commercial Outpatient Benefit Prior Authorization Behavioral Health Procedure Code List
- 2022 Commercial Outpatient Benefit Prior Authorization ASO Medical Surgical Procedure Code
- 2022 Commercial Outpatient Benefit Prior Authorization Fully Insured Medical Surgical Procedure Code List
- 2022 Commercial Specialty Pharmacy Prior Authorization Drug List
- 2021 Prior Authorization Requirements - Summary of Services
- 2021 Commercial Outpatient Benefit Preauthorization Behavioral Health Procedure Code List for FI & ASO members
- 2021 Commercial Outpatient Benefit Prior Authorization ASO Medical Surgical Procedure Code List
- 2021 Commercial Outpatient Benefit Prior Authorization Fully Insured Medical Surgical Procedure Code List
- 2021 Specialty Pharmacy Infusion Site of Care Benefit Preauthorization Drug List