Prior Authorizations

Electronic Prior Authorization Submissions

Submit your prior authorization (PA) requests electronically through our preferred solution CoverMyMeds.

Electronic prior authorization (ePA) automates the PA process making it a quick and simple way to complete PA requests. The ePA process is HIPAA compliant and enables faster determinations.

For select drugs and plans, CoverMyMeds may issue immediate approval of your request and update your patient PA record to allow immediate claim adjudication.

Prior Authorization Review

Depending on the type of medication and whether any additional information is needed to process the PA request, the review process can take one day, a few days, or longer. Your assigned PA contact will guide you through the process if additional information is required. Please contact the Member Services Center at the number listed on this web page if you have questions about the PA review.

Requesting an Appeal

If a PA request is denied, instructions for the Appeals process will be included within the communication sent informing you of the decision. Additional contact information will also be provided within the communication. Please contact the Member Services Center at the number listed on this web page if you have questions about an appeal.

Contact Our Member Services Center

Toll Free: (800) 460-8988

TTY: (866) 492-9674

Prior Authorization Guidelines and Statistics

Health plans may have state specific criteria not listed below. Please check your patient’s Health Plan website for relevant criteria.

Prior Authorization Statistics

• Ambetter from Arkansas Health and Wellness Regulatory Report - By Diagnosis
• Ambetter from Arkansas Health and Wellness Regulatory Report - Approvals and Denials by Drug
• Ambetter from Arkansas Health and Wellness Regulatory Report - By Denial Reasons