Availity
Use Availity to check eligibility, submit claims, check status, view remittances, as well as a dedicated Payer Space that offers payer-specific application and important announcements for plan and policy updates.
Provider manual
Your source for commonly asked questions about healthcare coverage, claims procedures, policies and more.
Resource center
Find essential provider resources including forms, coverage policies, prior authorization details, clinical guidelines, and online tools.
Pharmacy
Access key pharmacy resources for providers, including medical and retail pharmacy information, prior authorization guidance, and legislative requirements.
Providers' News
Find updates on the latest policies and procedures for providers.
Coverage policy and pre-certification/pre-authorization
Find out which procedures are covered by a policy or if a procedure requires prior authorization.
Approval processes
Learn about the different types of approval processes.
InterQual® coverage policy guidelines
The InterQual® guidelines are used by our utilization management team to help assess whether a given medical condition and known or represented circumstances of a case support medical service(s) as the most appropriate treatment, or whether the medical condition/circumstances presented could be appropriately addressed with an alternative treatment. Use the self-registration tool at the link to create a login and view the criteria. Individuals without an email address should contact the plan to receive the criteria information via mail. Please consult your provider for applicable policies and/or criteria.