Find Care Providers & Drugs
Online Prior Authorization (PA)
UHA offers these online tools to help providers streamline the prior authorization process:
- Search tools to quickly look up UHA requirements for prescription drugs or medical services
- Our Online Prior Authorization system, which allows providers to submit and track prior authorizations for medical services electronically
Prior Authorization for Prescription Drugs
Prior Authorization for Medical Services
You can use our lookup tool below to find the drug you’re looking for, whether that drug requires prior authorization (PA), and the corresponding pharmacy benefit manager (PBM) or medical benefit manager (MBM) contact information. See below for how to look up medical services that require prior authorization.
Additional Resources
Prior Authorization for Prescription Drugs
Prior Authorization for Medical Services
Look here for prior authorization requirements for medical services
Need to find out if UHA requires prior authorization (PA) for a medical service? Use this search tool to look up medical services by CPT code, CPT code description, or prior authorization type. Please note that this list includes only CPT/HCPCS codes and that any prior authorization requirements apply to all UHA medical plans.
*Disclaimers:
1. Outpatient services rendered in an inpatient setting require prior authorization.
2. For members living in Hawaii, ALL out-of-state requests require prior authorization.
3. For members on the mainland, ALL ASC or hospital-based elective procedures require prior authorization.
4. UHA reserves the right to perform retrospective review for services that do not require prior authorization to validate if services rendered met payment determination criteria.
5. Durable medical equipment requires prior authorization if rental is greater than $100/month or purchase is greater than $500.
6. Prophylactic mastectomy requires prior authorization, but non-prophylactic mastectomies do not.
Prior Authorization for Prescription Drugs
Prior Authorization for Medical Services
Submit and track prior authorizations for medical services online
If you already submit your claims electronically, you can also submit your prior authorization (PA) requests electronically and receive your prior authorization response via our Online Prior Authorization system. Don’t have an account? Get one here.
Services that are medically necessary and a covered benefit under the eligible member’s health plan are usually paid automatically, but certain services require prior authorization before they can be provided. These services, especially those that may result in expensive procedures, undergo the prior authorization process to ensure those services will be covered.
We will decide within 15 days of receipt of your request for prior authorization. Read more about “medical necessity,” and details about services which require prior authorization in our Provider Handbook. Health Care Services is available to assist you with all prior authorization requests and advance notification requirements.