Prior Authorization
Prior authorizations
Information about prior authorization processing timeframes and incomplete prior authorization requests can be located in the Prior Authorization Requirements document linked below.
- Pharmacy authorizations
- BH Prior Authorizations: magellanhealth.com
- Prior Authorization Forms for all other services
- Prior Authorization Requirements
- Prior Authorization Annual Review Report SFY2023
- Dell Children’s Prior Authorization List Effective 1/1/2025
- Dell Children’s Prior Authorization List Effective 2/1/2025
- Children and Pregnant Women Case Management Under Authorization Process
Manage prior authorizations in the provider portal
Recently, we made some changes to our authorization process. You may have noticed that the Authorization button in the menu bar is now active. Clicking on the Authorization button in the provider portal will take you to a new screen to submit and manage prior authorizations.
- Access the provider portal to submit or manage prior authorizations at https://secure.healthx.com/Provider_2022.
- Sign on to the provider portal.
- Users of the portal must be tied to a provider TIN or re-register for portal access.
- Sign on to the provider portal.
- To access prior authorizations, click “Authorizations” on the top menu bar to be taken to the prior authorization portal within the provider portal.
In the prior authorization portal, you can:
- Submit a new authorization request
- View requests for your patients
- View an interactive dashboard showing the status of all new prior authorizations
- Search for an existing authorization
- Communicate directly with the Utilization Management team
Watch the training video to learn how to manage prior authorizations for medical, surgical and behavioral health inpatient and outpatient services in the portal.
For questions, call Provider Customer Services at 1-844-781-2343. Staff are available Monday through Friday from 8 a.m. to 5 p.m. Central time. Documentation and forms required for prior authorization requests are available on our provider portal through the Dell Children’s Health Plan.
Member assistance with prior authorizations
Members who have questions regarding prior authorizations may contact Member Services at 1-855-921-6284 (TTY 711), available Monday through Friday from 8 a.m. to 6 p.m. Central time.
Process for requesting a prior authorization Navitus processes pharmacy prior authorizations (PA) for Dell Children’s Health Plan.
The formulary, prior authorization criteria and the length of the prior authorization approval are determined by the Health and Human Services Commission (HHSC). Information regarding the formulary and the specific prior authorization criteria can be found at www.txvendordrug.com, ePocrates and SureScripts for ePrescribing.
Prescribers can access prior authorization forms online at www.navitus.com under the Providers section or have them faxed by customer care to the prescriber’s office. Prescribers will need to provide their NPI and state to access the portal. Completed forms can be faxed 24/7 to Navitus at 920-735-5312. Prescribers can also call Navitus customer care at 1-877-908-6023 (prescriber option) and speak with the PA department Monday through Friday, from 8 a.m. and 5 p.m. Central time, to submit a PA request over the phone.
After hours, providers will have the option to leave a voicemail. Decisions regarding prior authorizations will be made within 24 hours from the time Navitus receives the PA request. The provider will be notified by fax of the outcome, or verbally if an approval can be established during a phone request.
