Together with CCHP contracted providers are responsible for obtaining prior authorization before they provide services to covered members.
- Effective January 1, 2019, your office may need to submit prior authorization requests for medications differently for Together with CCHP, depending on if the drug falls to the medical benefit or the pharmacy benefit. Please be sure to read these instructions.
Submit Authorizations Online
All authorization requests must be submitted via the CareWebQI Authorization tool on the Provider Portal, including all supporting documentation.
- If it is determined at the time of claims submission that the request for the authorization was submitted after the date of service, the claim will deny.
- Out-of-network providers need to call 844-450-1926 for instructions on submitting their requests.
- Retro- and post-service requests: CCHP does not review requests for services that have already been provided.
- For services that need an authorization, CCHP requires a prior authorization to be submitted for review before the date of service.
- Inpatient admissions require notification within 24 hours of admission in the Authorization tool.
- Post-service requests will be returned to the provider to be adjudicated on appeal, except for emergency or urgent care services.
- Authorization does not guarantee either payment of benefits or the amount of benefits.
For questions or assistance with your authorization request, call Together with CCHP Clinical Services Department at 844-450-1926
Affirmative Statement - Children’s Community Health Plan (CCHP) wants its members to get the best possible care when they need it most. To ensure this, we use an auto authorization process, which is part of our Utilization Management (UM) program. UM decision-making is based only on appropriateness of care and service, and existence of coverage. CCHP does not specifically reward practitioners or other individuals for issuing denials of coverage. Financial incentives for UM decision makers do not encourage decisions that result in underutilization.