Prior Authorization/Referral Requirements Effective: 1/1/2019
All Non-Par Provider Requests Requires Authorization Regardless of Service
Services performed in hospital outpatient facility
Determined by Coastal Care Services
Private duty nursing for children age 20 or younger
Determined by Coastal Care Services
Physical / Occupational / Speech / Respiratory Therapies
Exclusions: Imaging rendered in the following settings DOES NOT require prior authorization:
Determined by Coastal Care Options
Orthotics/Prosthetics >$500 (carved out by Coastal)
No Prior authorization if in a clinic or office setting; prior authorization is required if done in an outpatient hospital setting
Exclusions: Imaging rendered in the following settings DOES NOT require prior authorization:
Determined by Beacon Health Options
Non-emergent Ground Ambulance Transport , Air Medical Transport (MTM)
Those services that fall under the medical benefit (eg Orthognathic surgery)
Determined by Coastal Care Options
Orthotics/Prosthetics >$500(carved out by Coastal)
Determined by Coastal Care Options
Determined by Coastal Care Options