Contact Us | Print Page | Report Abuse | Sign In | Join
Prior Authorization - Information for Physician Practices

MSNJ's Prior Authorization Report

MSNJ's  2017 House of Delegates Resolution Substitution 4A: Prior Authorization asked that MSNJ study the problems of prior authorization; compile prior authorization measures online; and work with the New Jersey Department of Banking and Insurance (NJ DOBI) and payers to streamline the process. Click on the image below to read our Study. 


Prior Authorization hurts patients and physicians. It's time to #FixPriorAuth

NJ Department of Banking & Insurance Independent Health Care Appeals Program (IHCAP):

DOBI's Independent Health Care Appeals Program established a three-stage appeal process to address payer denials of prior authorization/utilization management requests.

Notice

Physicians are required to post notice of this program in their offices. 

Electronic Prior Authorization (ePA) Information:

The 2016 CAQH Index indicates that the healthcare industry could save up to $412 million, nationally, by moving to ePA. 

Learn how to implement ePA in your practice:


Payer Policies

Below are links to payer prior authorization policies available online. This is not a comprehensive list, as many policies were only available to physicians through payer portals and payer policies change frequently. These links will be updated periodically; however, we cannot guarantee the accuracy or timeliness of the information provided. Before providing a service to a patient, it is recommended that you directly access the payer portal and contact the plan to determine whether prior authorization is required. 

Aetna

Aetna Better Health of NJ (Medicaid MCO)

Medical

Pharmaceutical

Aetna Medicare Advantage

Pharmaceutical

Amerigroup (Medicaid MCO)

Medical

Pharmaceutical

AmeriHealth

    Medical

    Pharmaceutical

    Cigna

    Medical

    Pharmaceutical

    Clover Health (Medicare)

    Medical

    Pharmaceutical

    Horizon

    Medical

    Pharmaceutical

    Horizon Medicare Blue

    Medical

    Pharmaceutical

    Horizon NJ Health (Medicaid MCO)

    Medical

    Pharmaceutical

    Medicare

    Medical

    Oxford

    Medical & Pharmaceutical

    Pharmaceutical

    Qualcare

    Medical

    United Healthcare

    Medical

    Pharmaceutical

    United Healthcare Community Plan (Medicaid MCO)

    Medical

    Pharmaceutical

    United Healthcare Medicare Solutions

    Medical

    Wellcare (Medicaid MCO)

      Medical

      Pharmaceutical

      Wellcare (Medicare)

      Medical

      Pharmaceutical

      >>View Patient Prior Authorization Page