Procedures Requiring Prior Authorization

The requesting provider is responsible for verifying the member’s eligibility and benefits on the date of service. Prior Authorization approval is subject to all plan limits and exclusions. Please note, Prior Authorization requirements apply to all in-network and out-of-network providers. Alliant Health Plans may need to assist in returning the Member to an in network Provider when it is medically safe.


The below list of services which require Prior Authorization is not inclusive. For prior authorization requirements by specific code, you may use the Prior Authorization Verification Tool located in your Provider Portal or in the Provider section of AlliantPlans.com, or contact Client Services at (800) 811-4793.

ADVANCED IMAGING

  • CT
  • PET
  • MRI
  • MRA
  • Magnetic Resonance Cholangiopancreatography
  • Magnetic Resonance Spectroscopy
  • Myocardial Perfusion Imaging
  • Magnetic Resonance Guidance

BEHAVIORAL HEALTH

  • Inpatient
  • Intensive Outpatient Treatment Program
  • Partial Hospitalization Program (PHP)
  • Residential Treatment Center services

CLINICAL TRIAL RELATED SERVICES

All covered services related to an approved clinical trial

DIALYSIS

All Dialysis