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Prior
Authorizations
Effective April 15,
2011 changes have been made to services that may or may not require Prior
Authorization.
Please following listings below and if you
have any questions, please don’t hesitate to call the assigned Prior
Authorization line.
Check the back of the
member's id card for the code located in the lower right corner.
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If the code on the
card is….
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Please Call…
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Or Fax to…..
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Prior Authorization List
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CPT Listing
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Medical &
Pharmacy
Line:
800-647-2240
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Medical PA Fax:
800-466-9854
Pharmacy PA Fax:
877-815-8751
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HCPC Code List
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Med Injectable List
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ARK-IPPO
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JOP-IPPO
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SFD-MHP-HRA
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STL-MHMO-RX
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ARK-IPPO-CVTY
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JOP-PPO-In
Area
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STL-ASO-PMBS
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STL-MPPO-RX
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ARK-MPPO-RX
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JOP-PPO-Out
of Area
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STL-CDHP
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STL-MRDS
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ARK-PPO
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SFD-IPPO
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STL-HMO-POS
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STL-PPO
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ARK-PPO-OOA
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SFD-MHP
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STL-IPPO
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STL-PPO-OOA
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If the code on the
card is…
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Please Call…
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Or Fax to…
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Prior Authorization List
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Medical PA Line:
800-330-8305
417-820-3182
Pharmacy PA Line:
800-647-2240
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Medical PA Fax:
417-820-7866
800-863-8040
Pharmacy PA Fax:
877-815-8751
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SFD-HMO
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SFD-MRDS
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SFD-MHMO-RX
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SFD-PPO-In
Area
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SFD-MPPO-RX
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SFD-PPO-Out
of Area
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If the code on the
card is…
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Please Call…
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Or Fax to…
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Prior
Authorization Listing
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Medical PA line:
877-910-2410
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Medical PA fax line:
417-820-7866
800-863-8040
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STL-SMHS-OOA
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STL-SSU-OKC
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STL-SSU-KAN
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STL-SSU-SJU
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STL-SSU-NWA
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STL-SSU-STE
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STL-SSU-OKA
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SFD-ASO-SJHS
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STL-SJMHC (Pharmacy benefits for St. John’s St. Louis employee’s are
managed
Through
LDI)
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Prior Authorization
means precertification review by the plan before services and treatment are
rendered to determine if the
service meets the
criteria as a Covered Health Service.
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