Important information: After reviewing a prior authorization request, we will let our member, their primary care physician (PCP), and the requesting provider (if not the member’s PCP) know whether the request has been fully approved, partially approved, or denied.
If we deny the request, we also include information about the coverage guidelines and policies we used to make our decision.
Submitting all relevant clinical information at the time of the request will help expedite the determination. If additional clinical information is required, a CarePlus representative will contact the individual who submitted the prior authorization request and request the specific information needed to complete the authorization process.
Prior Authorization Request Options
Skip the paperwork
Availity Essentials™ offers more options and flexibility when submitting prior authorization requests.
Check patient eligibility and coverage, submit prior authorizations, submit claims, review previously submitted claims and more
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Availity Essentials
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Submit via phone
CarePlus Health Services Department: 800-201-4305
Do you have questions about the Medical and Medication Prior Authorization Lists or need help accessing Availity? Please call your designated provider services executive or call the Provider Services at 866-220-5448, Monday to Friday, 8 a.m. – 5 p.m., Eastern time.
To prevent disruption of care, CarePlus does not require prior authorization for basic Medicare benefits during the first 90 days of a new member’s enrollment for active courses of treatment that started prior to the enrollment. CarePlus may review the services furnished during that active course of treatment against permissible coverage criteria when determining payment.
