Providers

Prior Authorization Guidelines

Prior Authorization

At Health Choice Utah, our goal is to work closely with you and your practice team to streamline and expedite prior authorization. Many of the items on our abbreviated prior authorization list ask for notification only. Our centralized prior authorization center is designed to streamline processes resulting in timely expedited approval of prior authorization requests.

Prior Authorization Guidelines

Requests for services that require prior authorization can be submitted on the Health Choice Utah Prior Authorization form by fax or requests can be phoned into the Health Choice Prior Authorizations department. All requests must include complete diagnosis and procedure codes, and the accompanying medical documentation (as needed).

In order to expedite prior authorization and provide quality services to our members, a contracted or preferred provider is recommended for all healthcare services for Health Choice members. Please note that all non-contracted providers must obtain authorization for any service.

Services Requiring Prior Authorization

Medical Drugs Requiring Prior Authorization Effective 10/01/2022

To request a prior authorization electronically, use our Prior Authorization form.

Submitting a Prior Authorization Request

To submit a new request, obtain information about a previously submitted request or to make an urgent request:

  • Health Choice Utah Medical PA Phone: 1-877-358-8797
  • Health Choice Utah Medical PA Fax Line: 1-877-358-8793

Pharmacy Prior Authorization Request

Health Choice Utah may require prior authorization for certain drugs. Prior authorization will need to be obtained for medications noted with a “PA” in the drug list and for all unlisted medications. Providers need to get approval from Health Choice Utah before prescriptions are filled. Please refer to the Health Choice Utah Formulary to find out if a drug requires Prior Authorization.

For your convenience, click here to obtain the Medication Prior Authorization Form.

You can also request a Retail Pharmacy Prior Authorization or exception by submitting the Retail Pharmacy Prior Authorization Request Form.

Note: Pharmacy prior authorization ONLY. Medical prior authorization requests (including J-code) may be submitted via the Provider Portal.

Guides and Forms

Management of Expedited PA Request Notice
Services Requiring Prior Authorization
Medical Drugs Requiring Prior Authorization Effective 10/01/2022
Retail Pharmacy Prior Authorization Request Form
Medical Services Prior Authorization Form
Residential Treatment Prior Authorization Form
Synagis Authorization Form
Medical Documentation Submission Form

Online Medical Service Prior Authorization Form

Prior Authorization for Prescription Drugs
For more information about prior authorization for prescription drugs, click here.

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