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.
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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
- Prior authorization Requirement Changes Due to Semi-Annual Medicaid Cost of Care Review
- For Substance Use Disorder (SUD) Providers: Prior Authorization and Billing Update
- Prior Authorization Requirements for Sublocade
- Prior Authorization Requirements for Paravertebral Facet Injection/Nerve Block/Neurolysis
- Provider's Guide to Prior Authorization for Specialty Medications
- Chimeric Antigen Receptor T-cell Therapy Requires Prior Authorization for all Places of Service
- Prior Authorization for Electrical Stimulation Device
- List of Drug Codes to Require Prior Authorization
- Prior Authorization Requirements for Darzalex Drug
- Prior Authorization Requirements For Injection Infliximab-dyyb, Biosimilar and Infliximab-abda, Biosimilar
- Prior Authorization Requirements for Interferon Beta-1a
- Prior Authorization Requirements for Cabazitaxel
- Prior Authorization Requirements for Injectable/Infusible Drugs: Mepolizumab (Nucala) and Reslizumab (Cinqair)
- Prior Authorization Requirement Update for Mylotarg
- 8 Injectable Drugs that Require Prior Authorizaton
- Prior Authorization Requirement Update for Elotuzumab
- 5 Injectable Drugs that Require Prior Authorizaton
- Wheelchair Component or Accessory, not otherwise Specified to Require Prior Authorization
- Steps to Submit Prior Authorization Requests for Synagis and Makena
- Genetic Testing Services to Require Prior Authorization
- Intracardiac Electrophysiological Studies and Catheter Ablation to Require Prior Authorization
- Elective One and Two Vessel Coronary Artery Bypass Graft Medical Necessity Reviews
- Medical Necessity Reviews for Istodax (Romidepsin), Ixempra (Ixabepilone), Doxil (Doxorubicin), Torisel (Temsirolimus) and Inflectra (Infliximab-dyyb)
- Drugs for Medical Necessity Reviews
- Vascular Embolization or Occlusion Services Medical Necessity Reviews
- Knee and Spinal Orthoses Medical Necessity Reviews
- Prior Authorization Requirements for Hysterectomy
- Scoliosis and Spinal Deformity Medical Necessity Reviews
- Medical Injectables Prior Authorization Request Fax Number
- Mandated Sovaldi Patient Consent Form: Include with Sovaldi Prior Authorization Request
* Availity, LLC is an independent company providing administrative support services on behalf of UniCare Health Plan of West Virginia, Inc.
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