• Non-emergent ground or air ambulance

• Home health care - Limited to 100 visits per calendar year

• Home infusion therapy;

• Hospice – Requires physician statement of life expectancy of six months or less

• Durable medical equipment (DME)

• Out-patient mental health/substance abuse visits – Certification is required for any visit exceeding the first fifteen (15) visits

• Chiropractic therapy – Certification is required for any visits exceeding the first twenty visits. There is a maximum of sixty visits per year

• Physical therapy – Certification is required for any visits exceeding the first twenty visits. There is a maximum of sixty visits per year

• Occupational and speech therapy - Certification is required for any visits exceeding the first twenty visits. There is a maximum of sixty visits per year for each type of therapy

• Oral surgery

• Temporomandibular Joint Dysfunction (TMD)

• Botox injections

To obtain certification, please have your provider contact the Health Care Management Division at 405-717-8879 or toll free 1-800-543-6044, ext. 8879.

Failure to obtain prior authorization will result in a 10% penalty of the allowed charge.