Prior Authorization
Know What’s Required for Your Plan
At MetroPlusHealth, we are committed to streamlining the prior authorization process for our members. Our Prior Authorizations page offers easy access to prior authorization guidelines, request forms, and service-specific requirements to ensure timely, coordinated care for our members.
Helpful Resources:
Members in our Medicaid and Medicare plans can find details below on the types of forms and services that require prior authorization (PA). For medical and behavioral health, view the table details to see when PA is needed.
The tables cover these plan types:
- Medicaid
- Child Health Plus (CHP)
- Enhanced (HARP) Plan
- Essential Plan
- Partnership in Care HIV SNP
- Managed Long-Term Care (MLTC)
- Medicare
- MetroPlus UltraCare (HMO D-SNP) – (MAP)
To comply with CMS Interoperability and Prior Authorization Final Rule we are providing you with prior authorization metrics. The report below is based on 2025 data, and has figures such as approval and denial levels, approvals after appeals; and response times for approval or denial of PA requests.