For some medical services, PCPs and Providers must request referrals and prior authorizations on behalf of Members. Specialists should submit requests for further care after the initial visit. In Tier 1, these requirements are minimal when Members receive care from Prime Providers and Facilities.
When authorizations are required, they must be approved by Prime Utilization Management before Members receive care. Prime has made these approvals faster and easier than ever.
In general, services and supplies must be Medically Necessary for the care and treatment of a covered Sickness, Accidental Injury, Pregnancy or other covered health care condition. To determine medical necessity, contact Prime at 877-234-5227 or fax clinical to Prime UM 909-235-4414.
In order to request a prior authorization, please click here to download the form and have only a PROVIDER submit on behalf of you.
Now you don’t have to wait for the authorization copy to be mailed to your address. You can login to our portal and view your authorizations status and print them at any time.
Click here for login instructions
For questions related to login details: Kindly call our Customer Service at 877-234-5227.
Registration is easy and will give you instantaneous access to your information.
Click here for instructions
GO GREEN ON MESA!
Members can now request an email reminder when a new Explanation of Benefits is available to view on MESA and request that you no longer receive paper copies in the mail.
