Division Of Financial Regulation, Department Of Consumer And Business Services Prior Authorization Lookup
Latest Division Of Financial Regulation, Department Of Consumer And Business Services prior authorization updates2
- Prior AuthAdministrative/Operational PolicyEff. 2015-04-01Final Order — Pioneer Educators Health Trust: Assessment of Civil Penalties and Remedial Requirements for Autism-Related Coverage and Claims HandlingFinal consent order resolving an investigation into Pioneer Educators Health Trust's 2015 plan design, claims and preauthorization handling for autism-related services (including ABA), imposing penalties and corrective requirements.All Division of Financial Regulation, Department of Consumer and Business Services updates
- Prior AuthAdministrative/Operational PolicyVolume III - Utilization Management Procedures (Mental Health Provider Reimbursement Carrier Data Call)Analysis of carriers' utilization management (prior authorization, concurrent review, retrospective review, outlier management) applied to behavioral health and medical providers for a set of outpatient procedure codes as required by Oregon SB 860; affects carriers and participating providers included in the data call.All Division of Financial Regulation, Department of Consumer and Business Services updates
Tool Description
Search Division Of Financial Regulation, Department Of Consumer And Business Servicesprior 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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