Prior Authorizations

CAUTION: Please be sure to select the correct fax number on the Authorization Form for your county/service area. Use of an incorrect fax number may cause unnecessary delays in getting your authorization request to the appropriate medical review team.

Please remember that patient confidentiality and privacy is protected under HIPAA, so using the correct form and fax number will ensure to protect you against inappropriate disclosures.

Medical Prior Authorizations

• 2025 Prior Authorization Request Form
• 2025 Medicare Prior Authorization Grid
  • Updated 7/15/2025
• CPT Codes for Combined Services and Procedures
  • Updated 7/15/2026
• Referral vs. Prior Authorization

Prior Authorization Requirement Changes for July 15, 2025

As a part of ATRIO Health Plans’ commitment to delivering high quality health insurance at a low cost, we evaluate our medical policies and clinical programs on an ongoing basis. In order to support this, codes will be added, updated, and/or removed for some of the requirements for Prior Authorizations.

In addition to adding and removing prior authorizations, we have bundled other codes together. For example, when your doctor submits a prior authorization for a procedure to implant a pacemaker, a prior authorization for the pacemaker device must also be submitted to ensure you are getting quality devices.

• Bundled Services and Items Prior Authorization Changes

Part D (Pharmacy) Prior Authorizations

Please submit an Online Coverage Determination Form, an Electronic Coverage Determination through CoverMyMeds

OR you may submit an: ATRIO Medimpact Medicare Part D Coverage Determination Request Form

CoverMyMeds Instructions / Tutorial

Click below to watch a tutorial for more information on using CoverMyMeds, including:

• How to log in
• Submitting a new ePA
• Checking the status of an existing request
• Renewing a request