Prior Authorization

FCP Drug Coverage PA Documents PA Forms

Requirements Services Metrics

In an increasingly complex health care environment, iCare is committed to offering solutions that help health care professionals save time and serve their patients. The prior authorization process is in place to assure iCare members receive the appropriate level of care and to mitigate potential fraud, waste, and abuse.

iCare Prior Authorization

Main Content

Updates from iCare’s Prior Authorization Department

Please note:

Effective 7/15/2026, iCare will require providers submit the Urine Drug Screen (UDS) Testing Prior Authorization Request Form, as well as additional documentation to support the level of service requested, for the following Presumptive & Definitive Drug Test codes:

Presumptive Drug Test codes: 80306, 80307.

Definitive Drug Test codes: G0481, G0482, G0483, G0659.

No Prior Authorization will be required for the following Drug Test codes: 80305, G0480.

New Urine Drug Screen Testing PA Form

Urine Drug Screen PA Form

Prior Authorization Forms

Outpatient PA Form Inpatient PA Form Subacute PA Form Behavioral Health PA Form

DHS Outpatient Mental Health Assessment & Treatment/Recovery Plan Form

To review for medical necessity, please submit the following:

Prior Authorization Request Form
Current Clinical Notes
Supporting Documentation
Physician/Provider Order

For further guidance, please visit the Authorization Requirements page.

These forms and other documents can be found on Prior Authorization Documents or Provider Documents.

Please reach out to the Prior Authorization Department with questions by calling 1-855-839-1032 or emailing paassistants@icarehealthplan.org.

Prior Authorization List (PAL)

Current PAL Summary of PAL Changes

To prevent disruption of care, iCare does not require prior authorization for basic Medicare benefits during the first 90 days of a new member's enrollment for active courses of treatment that started prior to the enrollment. iCare may review the services furnished during that active course of treatment against permissible coverage criteria when determining payment.

Personal Care Workers & PC Screening Tool

ForwardHealth requires persons who are requesting authorization for personal care (PC) service to complete and submit the Personal Care Screening Tool (PCST) form. Please read these instructions prior to completing the fillable form below:

Personal Care Screening Tool Instructions Personal Care Screening Tool

PCW Provider Guide PCW Referral Process

Personal Care Worker PA Fillable Form Personal Care Worker Fillable Checklist

These documents and other instructions can also be found on the Personal Care Services (PCW) page and Prior Authorization Documents Page.

Services and Procedures Requiring Prior Authorization/Utilization Management Review

Prior authorization is required for:

Behavioral Health (BH)
- BH Inpatient Hospitalization
- Partial Hospitalization Program (PHP)
- Intensive Outpatient Therapy (IOP)
Admission to a subacute facility (Skilled Nursing Facility, Long Term Acute Care Hospital, Inpatient Rehabilitation Facility)
Home health care services
Personal Care Services
Hospice
Select durable medical equipment
Select procedures
Outpatient physical, occupational, and speech therapy & cardiac and pulmonary rehabilitation
Transplants
Referrals
- For second (or addition) opinions
- Referrals to non-participating providers outside of the member’s home state
For Non-Medicaid certified Providers –All Services other than Emergency Services
All Category III procedure codes
Long term care services covered under iCare’s Family Care Partnership Program also require a service authorization request from the Interdisciplinary Team.

Please note that supporting clinical documentation is required for all prior authorization requests in order to determine medical necessity. Incomplete prior authorization requests may delay processing. iCare will not retro authorize services rendered prior to the submission of a prior authorization request.

For information about Pharmacy Part D prior authorizations, coverage determinations or formulary exceptions, visit the Drug Coverage Information for Providers page.

For authorization requirements, visit the Authorization Requirements page.

Should you need to file a formal complaint: Submit a CMS complaint form online

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Last Updated 3/23/26