Prior authorization is not required for emergency services.
Please note that Prior Authorization is not a guarantee of payment. It is a pre-service determination of medical necessity based on information provided at the time the prior authorization request is made. Allegian Choice retains the right to review the medical necessity of services, eligibility for services, and benefit limitations and exclusions after you receive the services.
Requesting Prior Authorization:
- Verify member eligibility prior to the provision of services.
- Complete appropriate referral/authorization form (OB/GYN, Medical or Pharmacy) and attach supporting documentation.
- Submit request via FAX to 866-315-6314
Medical Prior Authorization
Blast Fax July 18, 2016: Prior Authorization Guideline Updates
Prior Authorization/Referral Form
Prior Authorization List (Effective 7/1/16)
Pharmacy Prior Authorization
Allegian Choice has contracted with a Pharmacy Benefit Manager (PBM) called CVS Caremark to oversee our prescription drug program. Consult the formulary to determine if the medication prescribed requires a prior authorization. Complete the prior authorization form and submit to CVS Caremark.
View CVS Pharmacy Prior Authorization information and form
Attn: Exchange PA Dept.
1300 E Campbell Rd.
Richardson, Texas 75081
PPO - Pre-Certification Requirements
HMO - Pre-Certification Requirements
Prior Authorization Request Form for Health Care Services
Prior Authorization Request Form for Prescription Drug Benefits
Quick Reference Guide