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Providers: Authorizations

Certain items and services require prior authorization (pre-certification) to evaluate medical necessity and eligibility for coverage. See the current Authorization List to determine if prior authorization is required for general categories of services. See the Authorization List Code Reference companion document for details.

We use both internal and external resources in the authorization process. For the services listed below, the process is handled by the organizations indicated.

Behavioral Health - For all lines of business except Florida Hospital and Rosen TPA plans, authorizations are processed by Magellan Healthcare. Submit requests to Magellan through their website at magellanprovider.com or by calling 1.800.424.HFHP (4347).

Specialty Imaging, Echocardiograms, Sleep Studies and Positive Airway Pressure (PAP) Devices - Authorizations are processed by AIM Specialty Health (AIM). Submit requests to AIM or access clinical guidelines through their website at: aimspecialtyhealth.com

Spinal Procedures (surgeries, injections) - Effective 10/1/17, authorizations are processed by Palladian Health for all product lines except Adventist Health System and Rosen Employee Plans. For participating plans, submit requests to Palladian or access clinical guidelines through their website at palladianhealth.com.


All Other Authorization Requests – We encourage participating providers to request authorization through the online provider portal located at myHFHP.org/login. For certain services requested via the online portal, you will have an option to complete a questionnaire. The answers to this questionnaire may lead to an automatic approval. However, even if an automatic approval is not provided immediately, the information provided via the questionnaire will help Health First Health Plans reduce the review turnaround time. If you are a non–participating provider or encounter issues submitting via the online provider portal, please fax your authorization request to 1.855.328.0059 (toll-free) or 321.434.4271 (local). For additional assistance you may also call Customer Service toll-free at 1.844.522.5282.

Authorization List Documents:

Authorization Request Forms:

Formulary Prior Authorization Lists:

2020

2019

Last updated: 1/2/2020