DHA Prior Authorization Lookup
Latest DHA prior authorization updates6
- Prior AuthReimbursement/Payment PolicyEff. 2017-12-12Concurrent Hospice and Curative Care for Pediatric BeneficiariesThis policy governs coverage, preauthorization, and reimbursement of hospice services provided concurrently with medically necessary curative TRICARE Basic Program services for eligible beneficiaries under age 21 with a related terminal illness.All DHA updates
- Prior AuthReimbursement/Payment PolicyEff. 2016-10-03Reduction Of Payment For Noncompliance With Utilization Review RequirementsThis policy governs reductions in TRICARE provider payment when required preauthorization or preadmission authorization is not obtained. It applies to participating and nonparticipating providers, including network providers and participating Department of Veterans Affairs/Veterans Health Administration facilities.All DHA updates
- Prior AuthAdministrative/Operational PolicyCHAMPUS Claims Submission, Review, and PaymentThis policy governs the information, documentation, signatures, filing deadlines, preauthorization, review, and payment requirements for CHAMPUS claims under the Basic Program and ECHO. It affects beneficiaries, sponsors, participating and nonparticipating providers, CHAMPUS fiscal intermediaries, and OCHAMPUS.All DHA updates
- Prior AuthReimbursement/Payment PolicyProcessing and Payment of Home Infusion ClaimsRequirements for processing and paying TRICARE claims for home infusion services, including provider eligibility, preauthorization, reimbursement, coding, pricing, and exclusions.All DHA updates
- Prior AuthReimbursement/Payment PolicyProvider Payment Reductions for Missing PreauthorizationGoverns TRICARE contractor reductions to provider payments when required preauthorization is not obtained, including calculation, communication, reporting, and waiver procedures.All DHA updates
- Prior AuthAdministrative/Operational PolicySpecial Authorization RequirementsDHA Policy Manual section addressing special authorization requirements, including provider preauthorization obligations, exceptions, and retrospective review.All DHA updates
Tool Description
Search DHAprior 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 Authorization by Payer
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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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