Prior Authorization

Prior authorization is not required for emergency services.

Please note that Prior Authorization is not a guarantee of payment. It is a pre-service determination of medical necessity based on information provided at the time the prior authorization request is made. Harbor Choice retains the right to review the medical necessity of services, eligibility for services, and benefit limitations and exclusions after you receive the services.

Requesting Prior Authorization:

  • Verify member eligibility prior to the provision of services.
  • Complete appropriate referral/authorization form (OB/GYN, Medical or Pharmacy) and attach supporting documentation.
  • Submit request via FAX to 866-315-6314

Questions about covered services, the status of a referral or the need for authorization should be directed to: 866-420-6782

  

Medical Prior Authorization

Forms

  

Pharmacy Prior Authorization

Harbor Choice has contracted with a Pharmacy Benefit Manager (PBM), Navitus to oversee the prescription drug program. If a medication requires a prior authorization, complete the prior authorization form and submit to Navitus. You can submit the completed form via:

Fax: 855-668-8551

Phone: 866-333-2757

Mail:
Navitus
PO Box 1039
Appleton, WI 54912-1039

Online:

Log on to the Navitus provider portal.

From the menu of options on the lower left hand side, select the Commercial drop down menu and select the prior authorization forms as indicated below.