Capital Health Plan,
Capital Health Plan, Prior Authorization
CHP uses prior authorization/precertification for certain medical, surgical, and behavioral health services. Official provider guidance says providers should…
Short answer
CHP uses prior authorization/precertification for certain medical, surgical, and behavioral health services. Official provider guidance says providers should use the Universal Prior Authorization Form, and incomplete forms are not processed. CHP states…
Capital Health Plan, publishes service-specific prior authorization guidance. Start with the payer resource below, then confirm the member's plan and the requested service before care is scheduled or submitted.
At a glance
- CHP uses prior authorization/precertification for certain medical, surgical, and behavioral health services. Official provider guidance says providers should use the Universal Prior Authorization Form, and incomplete forms are not processed. CHP states determinations are communicated within 15 calendar days after receipt of all necessary information. Some services may not require an authorization number if they can be completed with a referral or PCP/specialist order, and the exact list of services requiring authorization varies by plan/service context.
- Authorization requirements vary by service and can differ for local participating practitioner services.
- The reviewed sources do not provide a single comprehensive service-level authorization grid for all lines of business.
- The official materials emphasize that some services may be completed with a referral or order rather than a separate authorization number.
Where to verify prior authorization requirements
How to submit prior authorization requests
-
Universal Prior Authorization Form
-
Provider/member request for approval before service
-
Contact Member Services / Network Services for plan-specific guidance
Information commonly required
- Complete the Universal Prior Authorization Form in full
- Do not submit incomplete requests
- Supporting clinical/medical necessity information as needed for the service
Turnaround notes and caveats
- All requests for prior authorization are processed and a determination is communicated within 15 calendar days of receipt of all necessary information.
- Authorization requirements vary by service and can differ for local participating practitioner services.
- The reviewed sources do not provide a single comprehensive service-level authorization grid for all lines of business.
- The official materials emphasize that some services may be completed with a referral or order rather than a separate authorization number.
Provider resources
- Provider Care Resources (official)
- Network Support Services (official)
- Provider FAQ (official)
- Provider Directory (official)
- Referrals and Prior Authorization (official)
Sources
| Fact | Value | Source | Confidence |
|---|---|---|---|
| Provider FAQ: prior authorization process | Providers must utilize the Universal Prior Authorization Form and complete it in full; incomplete forms will not be considered a valid request and will not be processed. | Official | high |
| Provider FAQ: turnaround time | All requests for prior authorization are processed and a determination is communicated within 15 calendar days of receipt of all necessary information. | Official | high |
| Prior authorization overview | Prior authorization is required before receiving specific items and services; it reviews medical necessity and coverage. | Official | high |
| Services requiring prior authorization | All services by a non-contracted provider that is not an emergency service require prior authorization. | Official | medium |
Last reviewed: March 27, 2026
Sources used: 3 official
Automating prior authorization work
Clark Street Health is testing early-access workflows for requirements checks, status follow-up, document routing, and staff exceptions. Payer rules and clinical decisions still need the controls defined by your practice.
Review the prior authorization workflow