Providers are required to verify member eligibility before submitting a request for authorization.
Some medications require prior authorization. (For injectable or intravenous medications provided in a clinic, office, or home setting, see the medical and behavioral health services section below.)
Pharmacy prior authorization requirements are embedded in the Medicaid list of covered drugs (Formulary) document below. Medications requiring authorization are designated by the initials PA within the special code column in the drug listing.
Medicaid list of covered drugs (Formulary) – effective 9/1/2022 (PDF)
List of covered drugs for SNBC members with Medicare coverage (Formulary) - effective 9/1/2021 (PDF)
Prescription drug prior authorization form (PDF) - For a medication that requires prior authorization or is considered non-formulary.
Prescription drug reconsideration request (PDF)
Some health care services given to our members require prior authorization. Providers are responsible to verify eligibility and benefits before providing services to members.
Prior authorization list for medical and behavioral health services (PDF) - Our prior authorization list outlines which services require prior authorization or notification to Hennepin Health.
Standard service requests submitted on a pre-service or concurrent basis are reviewed and completed within 10 business days of receipt. If you submit a standard request for services that have ended (i.e., a post-service request), the review time is 30 calendar days.
Urgent requests are reviewed and completed within 72 hours. Use an urgent request when a standard review time:
Send forms via secure fax: Inpatient notifications: 612-288-2878 ǀ Service authorizations: 612-677-6222