Prior authorization

COVID-19 Communications Update: Resumption of Prior Authorization/ Precertification and Admissions Protocols

Click here for the latest Executive Order regarding resumption of prior authorization.

To determine if prior authorization (PA) is required for services use the Propat Tool 

Aetna Better Health of New Jersey requires prior authorization for select, acute outpatient services and planned hospital admissions. Prior authorization is not required for emergency services. A current list of the services that require authorization is available via the Provider Secure Web Portal. If you have questions about what is covered, consult your Provider Manual or call 1-855-232-3596.

Tips for requesting authorizations:

Remember, a request for prior authorization is not a guarantee of payment. Unauthorized services will not be reimbursed.

To request an authorization, find out what services require authorization or check on the status of an authorization, visit our Provider Secure Web Portal. For more information about prior authorization, review your Provider Manual.

You can also fax your authorization request to 1-844-797-7601.

View our Participating Provider Quick Reference Guide to quick tips and tools on submitting claims.

Use the quick reference guidelines linked below for additional prior authorization requirements:

Buprenorphine Prior Authorization Guidelines

Prior Authorization and Formulary Selection Procedures

Prescribing Opioids