How do I create an authorization?
Prior authorizations are required for specialist referrals, procedures, and certain medications.
Navigate to New Authorization
Log in to the Provider Portal. From the main dashboard, click Authorizations in the left navigation, then select New Authorization from the top-right corner of the page.
Search for the member
Enter the member’s ID, date of birth, or full name in the search field. The system will return matching members from your IPA roster. Select the correct member to confirm their current eligibility and IPA assignment before proceeding.
If the member does not appear, verify that their coverage is active and that they are assigned to your IPA. Contact Provider Relations if a member appears to be missing from your roster.
Select the service type
Choose the appropriate service category from the dropdown: Specialist Referral, Outpatient Procedure, Inpatient Admission, Imaging, or Pharmacy. The form will adjust to show only the fields relevant to the selected service type.
Enter diagnosis and procedure codes
Enter the ICD-10 diagnosis code and CPT procedure code for the requested service. You can search by code or description. The system will flag any combinations that require additional clinical justification or that do not meet standard criteria.
Attach clinical documentation
Upload any supporting clinical documents required for the authorization. Common documents include office notes, lab results, imaging reports, and letters of medical necessity. Accepted file formats are PDF, JPG, and PNG. Maximum file size is 20 MB per file.
Incomplete documentation is the leading cause of authorization delays. Ensure all requested documents are attached before submitting.
Submit and save your confirmation number
Review all information for accuracy, then click Submit Authorization. You will receive a confirmation number immediately. Save this number — you will need it to check the status of your request or contact Provider Relations about this authorization.
Standard processing time is 3–5 business days. Urgent requests may be submitted by phone for same-day review.