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Texas Insurance Regulation Preauthorization

For a detailed description of Aetna’s preauthorization process, please refer to our Member Handbook and Consumer Disclosures, which can be accessed from our website here.

 

For a current list of the health care services that Aetna requires preauthorization for and other relevant information about each of those services, please reference the following:

 

  • Aetna’s current participating provider precertification list and the effective date of those requirements can be found  here.
  • Supporting documentation needed to process precertification requests can be found under the “Medical Precertification” drop down on our website here. The Texas Department of Insurance (TDI) also provides additional forms that are optional to use.
  • Applicable screening criteria used by Aetna when deciding to approve or deny a precertification request can be accessed here.
  • Aetna provides transparency in our pharmacy prior authorization process, annual approval and denial utilization review results can be found here.

*Please note, it is the participating provider’s responsibility to initiate the preauthorization request on behalf of the member.

Legal notices

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.

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