Forms
Access forms for medical providers.
Coverage policy and pre-certification/pre-authorization
Find out which procedures are covered by a policy or if a procedure requires prior authorization.
Health Information Network
Use our Health Information Network to securely check eligibility, claims status and benefits online.
Providers' News
Find updates on the latest policies and procedures for providers.
Prior authorization
The primary coverage criteria of certain services must be established through a prior authorization process before they can be performed.
Hub Apply Portal
Provides information about updating credentialing and network status for providers and organizations.
Programs
Explore the programs designed to support you in delivering high‑quality, coordinated, and cost‑effective care.
HEDIS measures
Get details for specific HEDIS® Star measures.
Payment policy
Quickly search for payment policy information using a keyword, procedure code, policy number or title.
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.
Lucet medical necessity criteria and request forms
Lucet Health (Lucet) utilizes medical necessity criteria to make medical necessity determinations. The medical necessity criteria set applied varies according to the behavioral health service being requested. Please consult your provider for applicable policies and/or criteria.
Carelon clinical guidelines
The guidelines are designed to evaluate and direct the appropriate utilization of certain health care services. They are based on data from peer-reviewed scientific literature, criteria developed by specialty societies, and from guidelines adopted by other health providers. Please consult your provider for applicable policies and/or criteria.