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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. 

id card

 

If the code on the card is….

 Please Call…

Or Fax to…..

Prior Authorization List

CPT Listing

 

 

Medical &

Pharmacy

Line:

 

800-647-2240

 

 

Medical PA Fax:

800-466-9854

 

Pharmacy PA Fax:

877-815-8751

 

 

HCPC Code List

Med Injectable List

ARK-IPPO

JOP-IPPO

SFD-MHP-HRA

STL-MHMO-RX

ARK-IPPO-CVTY

JOP-PPO-In Area

STL-ASO-PMBS

STL-MPPO-RX

ARK-MPPO-RX

JOP-PPO-Out of Area

STL-CDHP

STL-MRDS

ARK-PPO

SFD-IPPO

STL-HMO-POS

STL-PPO

ARK-PPO-OOA

SFD-MHP

STL-IPPO

STL-PPO-OOA

If the code on the card is…

Please Call…

Or Fax to…

Prior Authorization List

Medical PA Line:

800-330-8305

417-820-3182

 

Pharmacy PA Line:

800-647-2240

Medical PA Fax:

417-820-7866

800-863-8040

 

Pharmacy PA Fax:

877-815-8751

SFD-HMO

SFD-MRDS

 

 

SFD-MHMO-RX

SFD-PPO-In Area

 

 

SFD-MPPO-RX

SFD-PPO-Out of Area

 

 

 

 

 

 

If the code on the card is…

Please Call…

Or Fax to…

Prior Authorization  Listing

Medical PA line:

877-910-2410

 

Medical PA fax line:

417-820-7866

800-863-8040

STL-SMHS-OOA

STL-SSU-OKC

STL-SSU-KAN

STL-SSU-SJU

STL-SSU-NWA

STL-SSU-STE

STL-SSU-OKA

SFD-ASO-SJHS

STL-SJMHC  (Pharmacy benefits for St. John’s St. Louis employee’s are managed

Through LDI)

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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