Physical Health, Behavioral Health and Long-term Services and Supports (LTSS) Prior Authorizations
For faster, self-service submit prior authorization requests using the ACS Provider Portal for online admission, concurrent review, and discharge prior authorization. The portal is available 24/7 to receive electronic submissions.
ACS Portal
Call: 919-651-8500 Monday through Saturday, 7:00 a.m. to 6:00 p.m. ET, except on North Carolina holidays
Fax: 919-651-8691 (Out-of-Network)
Email: [email protected]
Access training on how to submit a prior authorization to Alliance.
Alliance Vendor Prior Authorization Submissions
Alliance utilizes the following Utilization Management vendors for select service lines:
Navitus – Pharmacy Benefits Manager
Access pharmacy guidance for providers.
Northwood – Durable Medical Equipment (DME)
Provider Portal
Fax: 877-403-6164
Avesis – Vision Services
Provider Portal
Fax: 855-591-3566
ModivCare – Non-Emergent Medical Transportation (NEMT)
Portal login
WellCare – Imaging, Complex labs, musculoskeletal and Radiation Oncology
Provider Portal
WellCare may also use sub-delegates to process requests for certain services including:
NIA: https://www1.radmd.com/radmd-home.aspx
Service Code Lookup Tool
Before submitting your request, verify the service you are providing requires Prior Authorization by using Service Code Lookup Tool (www.alliancehealthplan.org). The list of services requiring prior authorization is subject to change.
North Carolina Medicaid Prior Authorization Request Forms and Attachments
Forms that should be used to submit or accompany a PA request. Missing or incomplete forms may delay your Prior Authorization request.
Referrals
Alliance Health does not require referrals for services. Members eligible to receive covered services from an Indian Health Coverage Program (IHCP) have direct access to services provided by the IHCP without referral or prior authorization.
