Benefit Grids

The following Benefit Grids outline service codes, service limits, level of care and documentation requirements needed for service authorization requests (SARs). They also outline requirements for unmanaged services.

Service Pre-Authorization Lookup Tool

Partners’ Service Pre-Authorization Lookup Tool provides authorization requirements by service code. We have made every attempt to ensure the most current information is included in the Pre-Authorization Lookup Tool. However, use of this tool does not guarantee payment. It is the provider’s responsibility to ensure proper eligibility, coverage benefits, provider contracts, correct coding and billing practices are followed. You may also refer to the Partners Benefit Grids or enter an authorization request into ProAuth.

Enter the base code of the service you would like to check, and then select a mod:

Updated: January 16, 2024