VA precertification/prior authorization list change notification June 1, 2025

The following services will be added to precertification/prior authorization for the effective dates listed below.

Precertification/prior authorization responsibility

The ordering or rendering provider of service is responsible for completing the precertification/prior authorization process.

If the requirements are not met, those services may be deemed ineligible for payment.

Providers may appeal online through Availity Essentials (https://Availity.com) or by calling Provider Services at the number on the back of our member’s ID card, with additional information, which may include medical records.

HMO plans: HMO members may not have benefits for non-emergency services rendered outside of the network and are subject to review.

PPO plans: Precertification/prior authorization for services requiring prior approval is highly recommended.

EPO plans: Precertification/prior authorization for services requiring prior approval is highly recommended. No out-of-network benefit is available with the exception of ER/urgent care and authorized services.

To request precertification/prior authorization with the Virginia plan
Access Availity Essentials at https://Availity.com.

For maternity, medical, and surgical precertification/prior authorization, call the number listed on the back of the member’s ID card.

For mental health and substance use precertification/prior authorization, call 800-755-0851. Professionals are available 24 hours a day, seven days a week.

Add to precertification/prior authorization