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Prior authorization (PA)

Prior authorization is required for some out-of-network providers, outpatient care and planned hospital admissions. We don’t require PA for emergency care. You can find a current list of the services that need PA on the Provider Portal. You can also find out if a service needs PA by using ProPAT, our online prior authorization search tool. 

 

Search ProPAT

 

Questions?

Check out your provider manual (PDF). Or call Provider Relations at at 1-800-279-1878 (TTY: 711). We’re here for you Monday through Friday, 8 AM to 6 PM. 

Tips for requesting PA

Tips for requesting PA

A request for PA doesn’t guarantee payment. We can’t reimburse you for unauthorized services. You can make requesting PA easier with these tips:

 

  • Register for Availity if you haven’t already.
  • Verify member eligibility before providing services.
  • Attach supporting documents when you submit the form. 

Learn more about utilization management (UM)

How to request PA

You can request PA: 

 

Online: 

You can ask for PA through Availity. 

 

By fax: 

Download our PA request form (PDF). Then, fax it to us at: 

PA for Legacy M4: 866-669-2454

PA Legacy Plus: 855-661-1828 

 

By phone:

Call 1-800-279-1878 (TTY: 711). You can call 24 hours a day, 7 days a week. For after-hours or weekend inquiries, just choose the Prior Authorization option to leave a voicemail, and we’ll return your call. 

 

For scheduled ambulatory surgery, be sure to call at least 72 hours prior to the surgery. 

For LTSS authorization requirements, visit the Department of Medical Assistance website.

 

You can use the materials found there to determine which forms are required for LTSS authorization from Aetna Better Health® of Virginia. You can fax all LTSS authorization requests to 1-844-459-6680.

Find the form you need. Then, fax it to us at 1-833-280-5224. Be sure to add any supporting materials for the review.

Find the form you need. Then, fax it to us at 1-844-459-6680. Be sure to add any supporting materials for the review.

Fax your request to us at 1-877-817-3707.

Find the ARTS form you need. Or find the mental health services form you need. Then, fax it to us at 1-833-757-1583. Be sure to add any supporting materials for the review.

Download our PA request form (PDF). Then, fax it to us at 1-844-956-1191. Be sure to add any supporting materials for the review. 

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