Celtic Insurance Company Prior Authorization

Celtic Insurance Company prior authorization rules are often service-specific rather than universal, so the safest workflow is to confirm the requirement in the payer's provider resources before scheduling or submitting care. The notes below summarize the most actionable provider-side guidance captured in the research set for this payer.

At a glance

• Celtic’s individual health plan materials state that some covered services require prior authorization. The policy language says network providers generally must obtain authorization before providing certain services, and authorization should be obtained by telephone using the number on the member ID card. The policy language also states that failure to obtain prior authorization can reduce benefits by 20% of eligible expenses related to the treatment, except for emergencies where notice should be given as soon as reasonably possible after the emergency.
• Prior authorization requirements may vary by state and plan.
• The cited policy materials are individual plan booklets/brochures rather than a centralized provider manual.
• The official site content retrieved does not show a web portal or ePA tool specific to Celtic provider authorization requests.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2

How to submit prior authorization requests

• telephone

• Submission resource 1

Information commonly required

• member identification card number / telephone number on the card for authorization contact
• service or supply being requested
• whether the service is inpatient, outpatient, emergency-related, or referred by a non-network provider

Turnaround notes and caveats

• For one plan document, concurrent review determinations are made within one working day of all necessary information and retrospective review determinations within thirty working days of receiving all necessary information.
• For adverse determinations, the provider is notified by telephone within twenty-four hours and written/electronic confirmation follows within one working day.
• Emergency services are treated differently; the policy language says benefits are not reduced for failure to comply prior to an emergency, but the payer should be contacted as soon as reasonably possible afterward.
• Prior authorization requirements may vary by state and plan.
• The cited policy materials are individual plan booklets/brochures rather than a centralized provider manual.
• The official site content retrieved does not show a web portal or ePA tool specific to Celtic provider authorization requests.

Provider resources

• Find a Doctor or Hospital / Provider directory landing page (official)
• Provider Directories landing page (official)
• Contact Us (official)
• For Members (official)

Sources