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Prior Authorization

“Prior Authorization” is a term used for select services (e.g., homecare services), items (e.g., Durable Medical Equipment purchases over $500) and prescriptions for some injectable or infusion drugs (e.g., Botox, Soliris, OxyContin) that must be pre-approved by Health Partners Plans. Prior Authorizations are sometimes referred to as “preauthorizations” or “precertifications” – they mean the same thing.

Note: Health Partners Plans requires prior authorizations for select services performed in an outpatient setting, including those performed in the office, short procedure units, ambulatory surgery centers, clinics, and hospital outpatient departments.

Prior Authorization Guidelines

Our Prior Authorization Guidelines provide an up-to-date list of all services requiring prior authorization. Prior authorizations are processed either through our provider portal or eviCore, depending on the type of service. Check out our Prior Authorization Management Tool to identify which services require submission through the provider portal or eviCore.

eviCore Prior Authorization Lists

Medical Drugs that require Prior Authorization

Pharmacy Prior Authorization Request Forms

If you want to request a non-formulary drug or a formulary drug that requires prior authorization, please use the appropriate forms as indicated below.

Health Partners (Medicaid), KidzPartners (CHIP)

Health Partners Medicare/Jefferson Health Plans (Medicare)

Jefferson Health Plans (Individual and Family Plans)

  • Drug-Specific Prior Authorization Forms (2024) — Use the appropriate request form to help ensure that all necessary information is provided for the requested drug.
  • Fax all completed IFP prior authorization request forms to 1-833-605-4407.