How Do I Prior Authorize Services?
All requests for certification are to be made by you or your physician’s office at least three (3) working days prior to the scheduled admission or requested service. In the event that health care services need to be provided within less than three (3) working days, you should contact the Health Services Department to request an expedited review.
To prior authorize, the Health Plan needs the following information:
- Name and ID# for the member requesting services
- Services being requested and the date those services are scheduled (if applicable)
- Specific information related to the member’s condition (if applicable – required for review against standard medical criteria)
The Health Services Department will review your medical request against standard criteria. Our Department is available between the hours of 8:00am and 5:00pm Central Standard Time, Monday through Friday, by calling our toll-free number 1-800-805-7938 or (605) 328-6807. After hours you may leave a message on the confidential voice mail of the Health Services Department and someone will return your call. The Member is ultimately responsible for obtaining prior authorization from the Health Services Department
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