Communityhealthchoice Prior Authorization Lookup
Latest Communityhealthchoice prior authorization updates5
- Prior AuthClinical/Medical PolicyEff. 2025-08-01Clinician Administered Drugs Site of Care PolicyGoverns the site of care for medication infusion services provided in hospital outpatient facilities to Community Health Choice members aged 18 years or older when billed under Place of Service 19 or 22. Hospital outpatient infusion is covered only when documented clinical, adherence, or pharmacy-timeliness factors make a non-hospital site inappropriate; additional medication-specific prior authorization may apply.All communityhealthchoice updates
- Prior AuthClinical/Medical PolicyEff. 2025-02-01Prior Authorization Criteria for KisunlaThis policy governs Medicaid and CHIP prior authorization for Kisunla infusion therapy for clients with Alzheimer's disease in Texas. It establishes initial approval, treatment monitoring, and renewal requirements for providers.All communityhealthchoice updates
- Prior AuthClinical/Medical PolicyEff. 2024-11-01Prior Authorization Criteria for Imdelltra (tarlatamab-dlle)This policy governs Medicaid and CHIP prior authorization for Imdelltra (tarlatamab-dlle) in adults with extensive-stage small cell lung cancer whose disease progressed after platinum-based chemotherapy. It applies to covered dates of service on or after November 1, 2024, in Texas Medicaid managed care and fee-for-service programs.All communityhealthchoice updates
- Prior AuthClinical/Medical PolicyEff. 2024-07-01SevenFact Criteria for CoverageThis policy governs medical-necessity review and prior authorization for SevenFact in Community Health Choice members with hemophilia A or B and high-titer factor inhibitors, including bleeding-episode treatment, control, and perioperative bleeding management.All communityhealthchoice updates
- Prior AuthClinical/Medical PolicyEff. 2024-05-01Trogarzo (ibalizumab-uiyk) Coverage CriteriaMedical-necessity and prior-authorization criteria for Trogarzo used with an optimized background antiretroviral regimen in members with HIV-1 infection.All communityhealthchoice updates
Tool Description
Search Communityhealthchoiceprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
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Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
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