Florida Health Care Plan, Prior Authorization

Florida Health Care 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

FHCP states that many services do not require prior authorization, but prior authorization is required for certain non-emergency services and for care outside the network/service area depending on plan rules. The provider resource guide says requests are generally submitted through the physician to FHCP Central Referral Department; the prior authorization form instructs providers to fax clinical information, and urgent requests must be called in first. Emergency care does not require prior authorization.
Exact prior authorization requirements vary by plan, network participation, and service type.
Official public pages indicate the provider portal contains referral/prior authorization workflows, but the public materials reviewed do not fully enumerate all portal steps.
The reviewed sources do not provide a single comprehensive public list of all services requiring authorization for every line of business.

Where to verify prior authorization requirements

How to submit prior authorization requests

Provider Portal electronic submission
Fax to Central Referral Department
Phone call for urgent requests
Mail/other written submission is not clearly specified for initial prior auth in the official sources reviewed
Submission resource 1

Information commonly required

Provider order/request for services or supplies
Patient name and date of birth
FHCP medical record number
Requesting provider name and contact details
Type of referral/request (routine or urgent)
Diagnosis and ICD-10 code
Procedure/service details and CPT code when applicable
Clinical documentation including labs, radiology, pathology, H&P, and provider notes

Turnaround notes and caveats

Routine medical referral/prior authorization decisions are stated as within 14 calendar days.
Urgent referrals are stated as 24-72 hours for a decision.
A member handbook also states pre-service claim determinations not involving urgent care are within 14 calendar days and may extend to 28 calendar days if additional information is needed.
Exact prior authorization requirements vary by plan, network participation, and service type.
Official public pages indicate the provider portal contains referral/prior authorization workflows, but the public materials reviewed do not fully enumerate all portal steps.
The reviewed sources do not provide a single comprehensive public list of all services requiring authorization for every line of business.

Provider resources

Provider Claims (official)
FHCP Provider Resource Guide (official)
FHCP Provider Resource Guide (alternate copy) (official)
Resources, Education & Support (official)
Prior Authorization Form (official)
Prior Authorizations FAQ (official)
Utilization Management (official)

Sources

Fact	Value	Source	Confidence
Most requests submitted via Central Referral Department; contact info and fax/phone on form	Providers are instructed to fax pertinent clinical information; urgent requests must be called in before submission.	Official	high
Routine and urgent turnaround times	Routine referrals are responded to within 14 calendar days; urgent referrals within 24-72 hours.	Official	high
Services that require authorization	Examples include all inpatient services, medications requiring authorization, out-of-network/non-participating non-emergency services, surgeries/procedures, transplants, PET scans, radiation therapy, and more.	Official	high
Emergency care exception	Prior authorization is never required for emergency care.	Official	high

Last reviewed: March 27, 2026

Sources used: 3 official