Preapproval, also called preauthorization, confirms that a service you're receiving will be eligible for benefits. By getting a service preapproved, you make sure the service is covered under your plan.
In most cases, your doctor will take care of getting a service preapproved, but not always. If you or your provider do not receive preapproval when required, your benefits may be reduced or not paid at all.
Which Services Need Preapproval?
How to Request Preapproval
Once you learn a service you’re having needs preapproval, you or your doctor must submit a request ahead of time. This allows time to review the service to make sure it's eligible for benefits.
For most services, including behavioral health services, you need to contact UniCare. For other services such as diagnostic imaging and specialty drugs, your doctor must contact AIM Specialty Health® at 866-766-0247 or providerportal.com. AIM is a UniCare-affiliated company that supports UniCare's preapproval process.
Information You Need to Provide
Have this information ready when you call for preapproval:
- Who is the UniCare enrollee – The name and UniCare ID number of the Plan enrollee
- Who is having the service – The name, birth date, and contact information of the member having the service (the Plan enrollee or a dependent)
- What and when is the service – The service or procedure, the diagnosis, and the scheduled date of service
- Where the service will take place – The name and contact information for the facility
- Who is the ordering doctor – The doctor's name and contact information
How to Reach UniCare Member Services
If you aren't sure whether you need to receive preapproval, or if you have other questions about preapprovals, please contact UniCare Member Services:
Basic, PLUS and Community Choice members
Call 833-663-4176 (TTY: 711)
Medicare Extension members
Call 800-442-9300 (TTY: 711)