Prior Authorization
What is prior authorization?
Some services need approval from PerformCare before you can use them. This is called prior authorization. When a service needs prior authorization, PerformCare must decide if it is medically necessary. You or your doctor must make a request to PerformCare for approval before you get the service.
A service that is “medically necessary” does one of the following:
- It will, or is reasonably expected to, prevent an illness, condition, or disability.
- It will, or is reasonably expected to, reduce or improve the physical, mental, or developmental effects of an illness, condition, injury, or disability.
- It will help you to get or keep the ability to perform daily tasks, taking into consideration both your abilities and the abilities of someone of the same age.
Asking for prior authorization
Click the following links to learn which services require prior authorization. PerformCare members can also call Member Services to ask about services that require prior authorization.
If you have questions about the prior authorization process, talk to your service provider or call Member Services using one of these phone numbers:
- Cumberland, Dauphin, Lancaster, Lebanon, and Perry counties: 1-888-722-8646
- Franklin and Fulton counties: 1-866-773-7917