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Prior authorization requirements

The most up-to-date listing of services requiring prior authorization is listed below.

Notification required

Prior authorization and referral updates

Medication requiring prior authorization

Services requiring prior authorization

The following is a list of services requiring prior authorization review for medical necessity and place of service.

* Prior authorization for CT scans, MRIs/MRAs and nuclear cardiology services are required for outpatient services only. The ordering physician is responsible for obtaining a prior authorization number for the study requested. Patient symptoms, past clinical history and prior treatment information will be requested and should be available at the time of the call. (Outpatient studies ordered after normal business hours or on weekends should be conducted by the ordering facility as requested by the ordering physician. However, the ordering physician must contact UM within 48 hours or the next business day to obtain proper authorization for the studies, which will be subject to medical necessity review.) Emergency room, observation care and inpatient imaging procedures do not require prior authorization.

* Members seeking information on sterilization services, hysterectomies (for sterilization purposes) and abortions should call AmeriHealth Caritas Louisiana. Abortion and sterilization services require prior authorization by AmeriHealth Caritas Louisiana. A representative will make necessary arrangements for members eligible for these services. However, members seeking information on hysterectomies for medical reasons not related to sterilization may contact Member Services at 1-888-756-0004.

Members with Medicare coverage may go to Medicare health care providers of choice for Medicare covered services, whether or not the Medicare health care provider has complied with AmeriHealth Caritas Louisiana's prior authorization requirements. AmeriHealth Caritas Louisiana's policies and procedures must be followed for non-covered Medicare services.