Prior authorization requirements

UniCare Health Plan of West Virginia, Inc. (UniCare) is available by fax or Interactive Care Reviewer (ICR) 24 hours a day, 7 days a week to accept prior authorization requests. 

Our ICR tool via Availity* is the preferred method for submitting prior authorization requests for physical health, offering a streamlined and efficient experience for providers requesting inpatient and outpatient medical services for our members. Additionally, providers can use this tool to make inquiries on previously submitted requests, regardless of how they were sent (phone, fax, Interactive Care [ICR] Reviewer or other online tool).

To request or check the status of a prior authorization request or decision for a particular plan member, access our ICR tool via Availity. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate.

Don’t have an Availity account?

Need help with Availity?

For help with prior authorization requests, you can also contact UniCare’s Utilization Management (UM) department: 

  • Phone: 1-866-655-7423
  • Hours: Monday to Friday, 8 a.m. to 5 p.m.
  • Preservice review fax: 1-855-402-6983
  • Current inpatient review fax: 1-855-402-6985
  • Behavioral Health inpatient fax: 1-855-325-5556
  • Behavioral Health outpatient fax: 1-855-325-5557

Services requiring prior authorization

UniCare’s Prior Authorization Lookup Tool Online (PLUTO) can assist with determining a code’s prior authorization requirements.

You can also refer to the provider manual  for information related to services that require prior authorization.

Behavioral Health

Fax all requests for services that require prior authorization to:

  • Behavioral Health inpatient fax: 1-855-325-5556
  • Behavioral Health outpatient fax: 1-855-325-5557

Pharmacy help desk (Molina)

  • Prescriber prior authorization:
  • Phone: 1-888-483-0801
  • Fax: 1-800-531-7787

Emergency medical services

UniCare does not require prior authorization for treatment of emergency medical conditions. In the event of an emergency, members may access emergency services 24/7. In the event that the emergency services result in the member’s admission to the hospital, providers must contact UniCare the next business day following admission. 

UniCare is available via fax at 1-855-402-6985 or ICR via Availity 24 hours a day, 7 days a week to accept emergent admission notification.

The following ALWAYS require prior authorization:

Elective services provided by or arranged at nonparticipating facilities

Related resources

* Availity, LLC is an independent company providing administrative support services on behalf of UniCare Health Plan of West Virginia, Inc.

Provider tools & resources

Interested in becoming a provider in the UniCare network?

We look forward to working with you to provide quality services to our members.