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Welcome to Summit Health

Prior authorizations and referrals

To help understand what services need prior authorization, Summit Health provides these prior authorization lists.

* Please note that Moda performs some administrative functions for Summit Health. Contact us if you need more help.

Prior authorizations for procedures and services (for Medicare members)

Please refer to these documents to help you determine if your patient needs a prior authorization:

 

Prior authorizations for behavioral health

For help with prior authorizations for behavioral health, see the Behavioral Health support page.  

 

Prior authorizations for pharmacy

For help with prior authorizations for pharmacy, see the Pharmacy support page.

 

Support by type of procedure or location


Ambulance icon

Inpatient support

Medical icon

Outpatient support

Scope icon

Advanced imaging / cardiology

Med kit icon

Musculo-skeletal support

Prescription icon

Injectables / infusions / specialty support

Medical Necessity Criteria

We have created a complete list of medical necessity criteria that is referenced throughout this section.

Prior authorization contacts

The Health Services Department can help with referrals on most procedures including the following:

  • Referrals
  • Inpatient Elective Procedures
  • Outpatient Selected Elective Procedures
  • Skilled Nursing Facility Long-Term Acute Care
  • Inpatient Rehabilitation
  • Home Health/Home Infusion
  • Hospice – Initial Evaluation and Service
  • Durable Medical Equipment (DME)
  • Transplants

Need assistance with any of the procedures listed above? Contact the Healthcare Services Department
844-931-1778

For help with Chemical Dependency and Mental Health authorizations
833-460-0445

Expedited requests

If you need help with getting a request expedited, please call Healthcare Services at 844-931-1778 or fax at 855-637-2666.

An expedited request is completed within 72 hours of receipt. Submitting an expedited request means that you are attesting that waiting for a decision under the standard time frame could place the enrollee’s life, health, or ability to regain maximum function in serious jeopardy.

Last updated Oct. 1, 2021
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Contact us

Have questions? We’re here to help. Call us today at 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. After March 31, your call will be handled by our automated phone system on weekends and holidays.

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