Prior Authorization Process

Certain procedures or services require plan approval or prior/pre authorization. This includes, but is not limited to, inpatient admissions, certain outpatient services, PET scans, and certain medications. The prior authorization process assures that the member is eligible, that the service is a covered benefit, and is medically appropriate. If, at the time of prior authorization, eligibility and coverage criteria are met, an authorization number is assigned by Cox HealthPlans (CHP). Please note the list of services requiring plan approval is subject to change.