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Welcome to Summit Health

Prior authorizations

Getting prior authorization for services

To request prior authorization, you or your provider can call Summit Health Customer Service at 844-931-1778. They can also fax our prior authorization request form (English) | prior authorization request form (En Español) to 855-637-2666.

When we say you need to get prior authorization for a service or prescription drug, it means that you need to get pre-approval from us to cover it. Prior authorization is also referred to as organization determination or coverage determination. Prior authorization is required for:

  • Ambulatory surgical center (ASC) services
  • Cardiac rehabilitation services
  • Diabetic services and supplies
  • Diagnostic radiology, MRI/CT/CAT/SPECT/PET, nuclear cardiology and radiation therapy
  • Durable medical equipment (DME) and related supplies
  • Home health
  • All home health visits, including skilled nursing, physical therapy, occupational therapy and speech language pathology in the home
  • Inpatient hospital care
  • Inpatient mental health care
  • Inpatient stay: covered services received in a hospital or skilled nursing facility (SNF) during a non-covered inpatient stay
  • Medicare Part B prescription drugs, home-infusion drugs and biologicals, see Step Therapy requirements for Medicare outpatient (Part B) medications for more details
  • Outpatient rehabilitation services, including physical therapy, occupational therapy and speech language pathology
  • Partial hospitalization services for mental health
  • Prosthetic devices and related supplies
  • Pulmonary rehabilitation services
  • Specialty dental services (Medicare-covered)

Getting prior authorization for prescription drugs

To request a prescription drug coverage determination, redetermination, or prior authorization, see our pharmacy coverage determination overview.

How to appeal a decision

You can request a review of a medical or pharmacy decision we have made. You can also file a complaint to Medicare.

Find information on how to file

Last updated Oct. 1, 2022

Contact us

Call 844-827-2355 (TTY users, please call 711).
Our customer service team is available from 7 a.m. to 8 p.m., Pacific Time, seven days a week from Oct. 1 to March 31, with the exception of Thanksgiving Day and Christmas Day.
After March 31, your call will be handled by our automated phone system on weekends and holidays.

Get more contact details