Direct referral
A member may be referred to another contracted CHA practitioner for certain services without prior authorization from CHA. Please refer to the CHA Quick Reference Guide to access the list of codes and services that do not require a prior authorization from CHA.
Prior authorization
Services that require prior approval by CHA before those services are rendered.
If approved, the authorization stays active for a specified date range and may expire. For extension requests, complicated cases, or any questions, contact CHA Provider Services at (800) 387-1103.
Services requiring prior authorization
For the most up-to-date information, download the CHA Quick Reference Guide available
| Specialist Services | |
| Hospital-based procedures & surgeries Ophthalmology services (exclude E&M) | Podiatry services All office-based services (excludes E&M) |
| Other Services | |
| Out of network providers Inpatient services Acupuncture Chiropractic services Dialysis Dr. Riba’s Health Club Durable Medical Equipment (DME) Genetic Testing Hearing Aids/Cochlear Implants | Home Health/Hospice/Palliative CareInfusion Injectable drugs, Chemotherapy Medical and Incontinence supplies Non-emergency medical transportation Orthotic and Prosthetics Surgical Procedures Therapy services (Physical, Occupational, Speech) |
How to Submit Prior Authorizations
Electronic Submission
- Go to https://eznet.rchsd.org/EZ-NET60/Login.aspx
- Sign in to your EZ-NET account o Under the Auth/Referrals tab, click Auth Submission
- Fill out each section, attach relevant medical records and submit.
Fax Submission
- Download and print CHA Prior Authorization Form. Fax the completed form to (855) 867-0868.
Authorization Processing Time
- Urgent Authorizations: within 72 hours
- Routine Authorizations: within 5 business days
- Retro-Authorizations: within 30 calendar days
Utilization Management Appeals and Provider Dispute Resolution Process
Providers may request reconsideration of an Authorization denial by submitting a formal appeal to CHA. Contact CHA Provider Services at (800) 387-1103 for more information.
Peer-to-Peer Review
Providers may contact a physician reviewer to discuss adverse determinations. The name of the reviewing physician and contact information is included in the authorization denial or may be obtained by contacting CHA Provider Services at (800) 387-1103.
Second Opinions
A member or the member’s authorized representative may request a second medical opinion by contacting CHA. CHA will review the request for medical necessity.
Referrals for second opinions should be directed to a provider who is contracted with the member’s health network. Referrals to non-contracting medical providers or facilities will be approved only when the requested services are not available within the contracting network.
If CHA denied a request by the member for a second opinion, CHA would notify the member in writing.
