Imperial Health Plan Prior Authorization

Imperial Health Plan 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

• Prior authorization is submitted through the Imperial provider portal and, depending on line of business/state and request type, may also be accepted by fax, hard copy, or orally. Texas Marketplace guidance states nonparticipating providers must submit prior authorization for all services by contacting Provider Services, and the portal can be used for digital submission/notifications.
• Prior authorization requirements vary by line of business and service; the official materials indicate some services do not require prior authorization and emergency medical/behavioral health services are exempt.
• The Texas Marketplace document is line-of-business specific; do not generalize its timelines to every Imperial product without verification.
• For some provider pages the portal is described generically rather than with a fully enumerated workflow; the portal URL is official, but detailed submission steps may require logged-in access.

Where to verify prior authorization requirements

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

How to submit prior authorization requests

• Provider portal

• Fax

• Hard copy

• Oral request

• Provider Services phone (for nonparticipating provider requests / assistance)

• Submission resource 1

• Submission resource 2

Information commonly required

• Member name
• Member ID number
• Member date of birth
• Requesting provider name and NPI
• Rendering provider name, NPI, and TIN
• Service requested (CPT/HCPCS/CDT)
• Service start and end dates
• Quantity/units requested
• Diagnosis code (recommended to prevent delays)
• Physician signature (recommended to prevent delays)
• Current clinical information
• Signed authorization form

Turnaround notes and caveats

• Texas Marketplace: standard requests may be extended up to 14 calendar days in some circumstances; expedited extensions may also be extended up to 14 calendar days if justified and in the member’s best interest.
• Texas Marketplace: routine/non-urgent determination time frame is 3 business days; urgent/expedited is 3 calendar days; concurrent is 1 business day; post-service is 30 calendar days.
• If information is incomplete, Imperial notifies the provider/member and requests resubmission with complete essential information.
• Prior authorization requirements vary by line of business and service; the official materials indicate some services do not require prior authorization and emergency medical/behavioral health services are exempt.
• The Texas Marketplace document is line-of-business specific; do not generalize its timelines to every Imperial product without verification.
• For some provider pages the portal is described generically rather than with a fully enumerated workflow; the portal URL is official, but detailed submission steps may require logged-in access.

Provider resources

• California provider page (official)
• Texas provider page (official)
• Provider manual (California / Imperial Health Plan of California, Inc.) (official)
• Exchange provider manual (2025) (official)
• Updated Exchange provider manual (2025) (official)
• Texas Marketplace prior authorization document (official)
• Transparency in Coverage / claim filing time limits (official)
• Provider portal (official)

Sources