ConnectiCare Prior Authorization Requirements (Commercial)

This list applies to ConnectiCare’s members with commercial benefit plans. It contains notification/prior authorization requirements for inpatient and outpatient services.

Updates to this list will be communicated through the Revision History sections and the provider newsletters.

Note: Some services may be benefit exclusions for some of our ConnectiCare Plans. Please verify member eligibility and benefits.

This list applies to ConnectiCare’s members with Marketplace benefit plans. It contains notification/prior authorization requirements for inpatient and outpatient services.

Updates to this list will be communicated through the provider newsletters.

Note: Some services may be benefit exclusions for some of our ConnectiCare Plans. Please verify member eligibility and benefits.

ConnectiCare Prior Authorization Requirements (Medicare 2026)

To find prior authorization requirements for specific codes, use the Prior Authorization LookUp Tool.

This list applies to ConnectiCare’s members with Medicare benefit plans. It contains notification/prior authorization requirements for inpatient and outpatient services.

Updates to this list will be communicated through the provider newsletters.

Note: Some services may be benefit exclusions for some of our ConnectiCare Plans. Please verify member eligibility and benefits.

ConnectiCare Prior Authorization Requirements (Medicare 2025)

This list applies to ConnectiCare’s members with Medicare benefit plans. It contains notification/prior authorization requirements for inpatient and outpatient services.

Updates to this list will be communicated through the provider newsletters.

Note: Some services may be benefit exclusions for some of our ConnectiCare Plans. Please verify member eligibility and benefits.

Radiation Oncology

Medication Oncology

Diagnosis Codes

Use these lists to see the medical and radiation oncology procedure, drug, and diagnosis codes that require prior authorization for Marketplace and Medicare members.

ConnectiCare Pharmacy Preauthorization List

Use this list to see the drugs that are associated with the member’s medical benefit.

Drug Preauthorization List

Use this list to see drugs that must meet clinical criteria in order to be covered under the member’s medical or pharmacy benefit.

Home Infusion Therapy Drug Preauthorization List

Use this list to see the home infusion therapy drugs that require prior authorization