Imperial Insurance Companies, Prior Authorization

Imperial Insurance Companies, 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

• Imperial’s provider manual says providers must obtain authorization for all services not listed on the Direct Referral Form before delivering those services. The UM department accepts requests by fax, written request, provider portal, or orally for standard and expedited preservice determinations, and it can receive requests from members or providers. The Texas Marketplace preauthorization document adds that incomplete requests trigger a notice requesting additional information within 3 business days, and standard/urgent timelines can be extended under certain conditions.
• The most detailed prior-authorization process found was in the provider manual and a Texas Marketplace-specific document; there may be additional plan-specific authorization rules not captured here.
• The manual says services not on the Direct Referral Form require authorization, so referral-based exceptions may exist.
• A response that prior authorization is not required is not an approval or a guarantee of payment.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2

How to submit prior authorization requests

• fax

• written request / hard copy

• provider portal

• oral request

• No direct topic-specific link was captured in the current research set.

Information commonly required

• member name
• member address and telephone number
• member ID number
• diagnosis codes (ICD-9/10) for applicable diagnoses
• requested service codes (CPT) for applicable services
• requested provider
• primary care physician or specialist name and TIN
• telephone and fax numbers
• clinical support information / medical necessity documentation
• indication whether the request is standard or expedited

Turnaround notes and caveats

• For Texas Marketplace, incomplete prior authorization documentation must be addressed with a notice sent no later than 3 business days after receipt.
• For Texas Marketplace, final determination after missing information is provided is completed within 3 business days.
• Texas Marketplace standard requests may be extended up to 14 calendar days in certain circumstances.
• Texas Marketplace expedited requests are generally within 72 hours and can also be extended up to 14 calendar days in limited circumstances.
• The provider manual states utilization review timelines vary by program and request type; for example, exchange routine/non-urgent 3 business days, urgent/expedited 3 calendar days, concurrent 1 business day, and post-service 30 calendar days.
• The most detailed prior-authorization process found was in the provider manual and a Texas Marketplace-specific document; there may be additional plan-specific authorization rules not captured here.
• The manual says services not on the Direct Referral Form require authorization, so referral-based exceptions may exist.
• A response that prior authorization is not required is not an approval or a guarantee of payment.

Provider resources

• Official provider landing page (California) (official)
• Official provider landing page (Texas) (official)
• Official provider landing page (Arizona) (official)
• Official provider landing page (Utah) (official)
• Official provider landing page (Nevada) (official)
• 2025 Provider Manual (PDF) (official)
• Texas Marketplace Preauthorization requirements (PDF) (official)

Sources