Elevance Health · Prior auth

Elevance Health prior authorization criteria

Submission criteria, documentation packets, and P2P prep by drug — for prescribers and PA staff. 30-day standard PA decision.

Standard PA decision

30 days

Appeal window if denied

180 days

Drugs covered

62

Elevance Health reviews prior-authorization requests against its published medical policies — diagnosis with ICD-10 code, documented step-therapy history, and prescriber attestation of medical necessity. Standard PA decisions return in 30 days; if denied, prescribers and members have 180 days to appeal. Criteria by drug below.

Prior authorization criteria by drug

Each page covers Elevance Health's submission criteria, the documentation packet, and peer-to-peer prep for that drug.

Generate a Elevance Health PA packet

Open ApprovalHelp — generate a prior-auth packet tailored to Elevance Health's criteria, with prescriber attestation and step-therapy documentation pre-filled.

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