Prior Auth Required

75261 - • Authorizations for members in our ASO (Administrative Services Only) plan types (payer ID ) should be submitted via email to

This procedure appears on the selected insurer prior authorization source.

Check another codeExplore policy data
Prior authorizationPrior Auth Required
Procedure / Service• Authorizations for members in our ASO (Administrative Services Only) plan types (payer ID ) should be submitted via email to
Procedure / Service Description

Master Service List (MSL) is subject to the requirements outlined in the member’s Summary Plan Description (SPD). You can access the - member’s SPD through the Provider Portal or by calling the member’s plan Customer Service number found in the General Information section. • Authorizations for members in our ASO (Administrative Services Only) plan types (payer ID 75261) should be submitted via email to ifbhealthmanagement@medica.com or via fax to 1 (608) 252-0830 on the relevant form found on our Utilization Management page under Prior Authorization Forms: Medical Management page for SSM Health Employees;

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.