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.
Please refer to these documents to help you determine if your patient needs a prior authorization:
For help with prior authorizations for behavioral health, see the Behavioral Health support page.
For help with prior authorizations for pharmacy, see the Pharmacy support page.
We have created a complete list of medical necessity criteria that is referenced throughout this section.
The Health Services Department can help with referrals on most procedures including the following:
Need assistance with any of the procedures listed above? Contact the Healthcare Services Department
For help with Chemical Dependency and Mental Health authorizations
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