Community Health Choice, Prior Authorization

Community Health Choice, 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

• Community Health Choice states that prior authorization is required for non-emergent services when the plan requires it, and that authorization does not guarantee payment. The provider page includes plan-specific guidance. For Medicaid/STAR+PLUS, routine prospective UM determinations are shown as within 3 business days in one section and 7 calendar days in another section of the same page, so that variation should be preserved. For Medicare, urgent determinations are within 72 hours, routine within 7 calendar days, and inpatient within 24 hours. For pharmacy, urgent requests are immediate if the prescriber calls, routine requests are answered within 24 hours, and a 72-hour supply may be allowed if Community cannot respond in time or the prescriber is unavailable after-hours. Retrospective review determinations are stated as within 30 calendar days after receipt of the request, with fax submission required.
• The provider prior authorization page repeats plan-specific sections and contains internally inconsistent timeframes across sections; the response preserves those differences instead of choosing one.
• Authorization does not guarantee payment.
• Failure to obtain required prior authorization may result in claim denial or administrative denial, depending on the section/plan described.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2
• Verification resource 3

How to submit prior authorization requests

• Fax

• Phone

• Provider Portal / web submission where plan-specific forms are offered

• Mail / paper forms where applicable

• Submission resource 1

• Submission resource 2

• Submission resource 3

Information commonly required

• Member name
• Member date of birth
• Member Medicaid/CHIP identification number
• Requesting provider name and NPI
• Servicing provider name and NPI
• Requested service
• Requested CPT codes
• Number of units requested
• Dates of service
• In-network requesting provider signature
• Supporting clinical documentation to validate medical necessity

Turnaround notes and caveats

• Medicaid/STAR+PLUS page shows prospective review timeframes that vary within the page: one section states urgent no later than 3 business days and routine within 3 business days; other sections state urgent no later than 72 hours, routine within 7 calendar days, and inpatient within 24 hours.
• Medicare prior authorization guidance states urgent as soon as possible and no later than 72 hours, routine within 7 calendar days, and inpatient within 24 hours.
• Retrospective review determinations are stated as within 30 calendar days from receipt of the request.
• The provider prior authorization page repeats plan-specific sections and contains internally inconsistent timeframes across sections; the response preserves those differences instead of choosing one.
• Authorization does not guarantee payment.
• Failure to obtain required prior authorization may result in claim denial or administrative denial, depending on the section/plan described.

Provider resources

• Provider Home (official)
• Resources (official)
• Forms and Guides (official)
• Prior Authorization Information (official)
• HIPAA / Electronic Claims (Marketplace) (official)
• Contact Community (official)
• Provider Claims Billing Guidelines (Jan 2026) (official)

Sources