Prior Authorization

This means that you will need to get approval from IU Health Plans (HMO) (HMOPOS) before the member fills their prescriptions for some drugs. If you don't get approval, IU Health Plans (HMO) (HMOPOS) may not cover the drug. You can find out which drugs require prior authorization by reviewing the Clarian Health Plans (HMO) (HMOPOS) Formulary. Usually, you will have to give us information about the member's medical condition or previous prescriptions in order to receive prior authorization.

Generally, we will give you and the member our decision within 72 hours of getting your request for standard coverage determinations or 24 hours of getting your request for an expedited coverage determination.

• Click here for the IU Health Plans (HMO) (HMOPOS) Drug Formulary

Providers who would like to submit a prior authorization request may either contact our Provider Help Desk at 1-866-907-7088, or use our physician's coverage determination form available below. Please answer all questions on the form and fax to the phone number listed on the form.

• Click here for the Physician's Coverage Determination Request Form. Fax or mail the completed form to:

IU Health Plans (HMO) (HMOPOS)
Prior Authorization Department
200 Stevens Drive
Philadelphia, PA 19113
Fax Standard: 1-866-429-2260
Fax Urgent: 1-866-497-1386

What can be done if a Coverage Determination is denied?
If IU Health Plans (HMO) (HMOPOS) denies the coverage determination the member or their representative has the right to request a redetermination appeal. Physicians and other prescribers, upon providing notice to the enrollee, have the right to request a redetermination appeal on a member's behalf. Please see our section on Appeals and Grievances for information about member appeal rights, or contact our Prescriber Appeals Department 8:00 a.m. - 8:00 p.m., seven days a week.

• Click here for more information on Appeals & Grievances.