Prior Authorization - Acute Care Services
Bravo Health Members should access care through their PCPs. If the PCP determines that specialty care, diagnostic testing, or other ancillary services are required, the PCP should refer the Member to an in-network provider. Certain services require prior authorization from Bravo Health.
To find out more about the prior authorization process for Acute Care Services, select one of the following:
Services that Require Prior Authorization
The following services require prior authorization:
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Non-emergency ambulance
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Audiology testing and hearing aids
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Behavioral health services after the 30th session
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Chemotherapy drugs
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DME – all rental as well as purchase, maintenance, or repair over $250
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Home health services
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Inpatient services
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Long term services and supports (LTSS)
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Outpatient surgeries/procedures in hospital as well as certain procedures in ASC (refer to complete list in Bravo Health’s Provider Manual)
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Psychological and Neuropsychological Testing
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Radiological procedures such as MRI, MRA,CT Scan, Pet Scan, maternity ultrasound
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Rehabilitative Therapy – OT/PT/ST, cardiac, pulmonary rehab
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Sleep studies
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TMJ treatments
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Transplant services
Providers should refer to Appendix D in Bravo Health's Provider Manual for a complete overview of services requiring authorization.
How to Request Prior Authorization for Acute Care Services
There are three ways to request a prior authorization.
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Fax a Prior Authorization Form for Acute Care Services to Bravo Health at the applicable fax number listed below.
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Home Health:
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1-877-809-0790
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Inpatient:
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1-877-809-0786
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Skilled Nursing Facility:
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1-877-809-0788
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Other Outpatient Requests:
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1-877-809-0787
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Request a Prior Authorization for Acute Care Services online through Bravo Health's Provider Portal.
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Speak with a Bravo Health representative in the Prior Authorization Department at 1-877-562-4402.
Prior Authorization Process
Bravo Health prioritizes prior authorization requests according to medical necessity. If a prior authorization request is approved, Bravo Health issues an authorization number that should be used for billing. Bravo Health faxes the approved Prior Authorization Request Form and the authorization number to the requesting provider according to the following timeframes:
Requests for authorization that are made after hours are reviewed the next business day.
To determine the status of an authorization request, call the Prior Authorization Department at 1-877-562-4402.
Standard Prior Authorization Request
If all required information is submitted at the time of the request, Bravo Health will respond to a Prior Authorization Request Form within three (3) business days of receipt of the request.
Expedited Authorization Request
An expedited request can be requested if a Provider believes that waiting for a decision under the standard request timeframe could place the Member’s life, health, or ability to regain maximum function in serious jeopardy. To request an expedited authorization, Providers should call 1-877-562-4402.
Emergency Admissions & Services
Prior authorization is not required for Emergency Services. However, Providers must notify Bravo Health of Emergency Services within twenty-four (24) hours or by the next business day, whichever is later.
Post Stabilization Prior Authorization Request
Post-stabilization requests can be made for covered services related to an Emergency Medical Condition provided after a Member has been stabilized. Bravo Health will respond to post-stabilization requests within one (1) hour.
Limits of Authorization
Authorizations for Acute Care Services are usually issued for thirty (30) days. Authorizations for LTSS are issued for up to twelve (12) months, depending on the service requested.
Prior Authorization Forms – Acute Care Services
Bravo Health maintains the following Prior Authorization Forms for Acute Care Services.
Inpatient Authorization Form
Providers should use the Inpatient Authorization Form to request authorization for an elective admission to any inpatient Medical or Behavioral facility.
Outpatient Authorization Form
Providers should use the Outpatient Authorization Form to request authorization for outpatient services (see Behavioral Health Services menu for available forms to request authorization for Behavioral Health Services).
To review the Prior Authorization process for LTSS providers, please see link for LTSS Providers under Resources for Providers.