Prior Authorizations

Services requiring prior authorizations are subject to change.

An enrollee does not need prior authorization to see a primary care physician.

AmeriHealth Caritas Next does not require referrals for any service.

Physical Health and Behavioral Health Prior Authorization

Prior Authorization Lookup Tool

Use our Prior Authorization Lookup Tool to find out if a service requires prior authorization.

Submit a prior authorization request for physical health or behavioral health services:

Online

Use Jiva for online prior authorization via our secure provider portal by signing on to NaviNet and accessing the Jiva portal.

By fax

Physical Health and Behavioral Health Prior Authorization forms are available in the forms section of the website.

Fax the Physical Health Prior authorization form to 1-844-412-7890.

Fax Behavioral Health prior authorization forms to 1-855-243-6352.

By phone

Call our Utilization Management department at 1-833-702-2262 from 8 a.m. to 5 p.m., Monday to Friday.

After hours, weekends and holidays

For emergency prior authorizations after hours, weekends and holidays, call the Nurse Call Line at 1-844-201-6797.

Pharmacy Prior Authorization

Use the following information to help you with pharmacy prior authorizations:

Online

Pharmacy prior authorizations can be found online of the PerformRxSM website

By phone

Call our Provider Services department at 1-844-280-9131 from 8 a.m. to 5 p.m., Monday to Friday.

By fax

The Pharmacy Prior Authorization form is available in the forms section of the website.

Fax to 1-855-756-9901.

For pharmacy prior authorizations after business hours, Saturdays, Sundays, and holidays, please call the 24/7 Pharmacy Enrollee Services number at 1-844-211-0968.