Skip to Main Content

Prior Authorization

Please note, failure to obtain authorization may result in administrative claim denials. Home State providers are contractually prohibited from holding any member financially liable for any service administratively denied by Home State for the failure of the provider to obtain timely authorization.

Prior Authorizations

Some services require prior authorization from Home State in order for reimbursement to be issued to the provider. Please use our Prior Authorization Prescreen tool to verify requirements.

Standard prior authorization requests should be submitted for medical necessity review at least five (5) business days before the scheduled service delivery date or as soon as the need for service is identified. Authorization requests may be submitted by fax, phone or secure web portal and should include all necessary clinical information. Urgent requests for prior authorization should be called in as soon as the need is identified.

Service Phone Number
Inpatient Services/Admissions/Fact Sheets/Census 1-866-390-2739
Outpatient Services 1-855-286-1811
Concurrent Review — Clinicals 1-866-390-3139
Behavioral Health Services 1-866-694-3649

Or login to submit a prior authorization.

Please visit our Tools & Resources section under “Forms” for prior authorization fax forms.
High Tech Imaging Services (CT, MRI, PET) are authorized by National Imaging Associates at

  • Emergency room and post stabilization services never require prior authorization.
  • All services in the home require authorization.
  • DME purchases costing $500 or more or rental of $250 more require prior authorization

Home State’s Medical Management department hours of operation are Monday through Friday from 8:00 a.m. to 5:00 p.m., CST (excluding holidays). After normal business hours, nurse advice line staff is available to answer questions and intake requests for prior authorization. 

Emergent and post-stabilization services do not require prior authorization. Urgent/emergent admissions require notification within one (1) business day following the admit date.

We will process authorization requests within 36 hours, which shall include one working day of obtaining all necessary information for routine services, not to exceed 14 calendar days following the receipt of the request.  Authorization determinations may be communicated to the provider by fax, phone, secure email, or secure web portal.