Medical Pre-Authorization

Prior Authorization Form

Requests for Pre-Authorization should be submitted to:

• Utilization Management Authorization: (202) 821-1100
• Utilization Management Fax Number: (202) 821-1098

Notification of Pregnancy Related Care

Prior Authorization is not needed for Pregnancy related care, however notification is required.  You may fax the OB Prior Authorization form to the UM department at (202) 821-1098. The OB/GYN is responsible for notifying the CareFirst CHPDC/Alere Case Manager at (202) 821-1100 for assistance with support services needed to help the pregnant enrollee during pregnancy. Any high-risk pregnancies due to physical, social or behavioral conditions must be reported to CareFirst CHPDC at the time of the first visit or at the time when the high-risk situation develops during the pregnancy. All high- risk conditions should be reported to the high-risk obstetrical case manager. The case manager can be contacted via phone (202) 821-1100. The high-risk case manager partners with the OB practitioner to provide reinforcement education for the high-risk condition and coordinate services needed. For high-risk situations that require consultation and/or management of a perinatologist, practitioners should contact the high-risk case manager at the number above. She/he will help the enrollee to contact the perinatologist for consultation and/or transition management.