Providers

Authorizations

Certain items and services require prior authorization (pre-certification) to evaluate medical necessity and eligibility for coverage. See the current Authorization List to determine if prior authorization is required for general categories of services. See the Authorization List Code Reference companion document for details.

We use both internal and external resources in the authorization process. For the services listed below, the process is handled by the organizations indicated.

Specialty Imaging – Authorizations are processed by AIM Specialty Health (AIM). Submit requests to AIM or access clinical guidelines through their website at: aimspecialtyhealth.com

Echocardiograms, Sleep Studies and Positive Airway Pressure (PAP) Devices – For all lines of business except Florida Hospital TPA and Rosen TPA plans, authorizations are processed by AIM Specialty Health (AIM). Submit requests to AIM or access clinical guidelines through their website at: aimspecialtyhealth.com. For Florida Hospital TPA and Rosen TPA plans, PAP devices are authorized by Florida Hospital Care Advantage.

Spinal Procedures (surgeries, injections) – Effective 4/1/17, for all lines of business except Florida Hospital TPA and Rosen TPA plans, authorizations are processed by Palladian Health. Submit requests to Palladian or access clinical guidelines through their website at: palladianhealth.com. For Florida Hospital TPA and Rosen TPA plans, spinal surgeries are authorized by Florida Hospital Care Advantage.

Behavioral Health – For all lines of business except Florida Hospital TPA and Rosen TPA plans, authorizations are processed by Magellan Healthcare. Submit requests to Magellan through their website at: magellanprovider.com or by calling 1.800.424.4347. For Florida Hospital TPA plans, authorizations are processed by Orlando Behavioral Administers (OBA). Contact OBA at 1.855.847.9419.

All Other Authorization Requests – Submit to Florida Hospital Care Advantage by faxing 1.855.328.0059.


Authorization List Documents:


Authorization Request Forms:


Clinical Guidelines:

Other clinical guidelines are available through organizations responsible for administering the authorization process.


For Florida Hospital Employee Plan:


For Rosen Employee Plan:


Last updated: 3/23/2017