Requesting Prior Authorization

Prior Authorization is a decision made by the plan regarding certain medical services that require pre-approval or prior to arrangement for health care services.  You, your representative, or your network Primary Care Provider (PCP), or the provider that delivers or intends to deliver services to you, may request a Prior Authorization by filling out a Request for Prior Authorization form. 

• You may request a prior authorization over the phone by calling us at 1-833-388-8168 (TTY: 711), 8 a.m. to 8 p.m., seven days a week, from October 1 through March 31, and 8 a.m. to 8 p.m., weekdays, from April 1 through September 30.
• Fax the completed form to 1-657-276-4719, or
• Mail to:

Clever Care
Attn: Utilization Management
7711 Center Avenue, Suite 100
Huntington Beach, CA 92647

Medical item or service decisions will be made no later than 72 hours after receipt for requests meeting the definition of Expedited (fast decision) and no later than 14 calendar days for requests meeting the definition for Standard.

For Part B drug determination, the turn-around time for a request is 72 hours for a standard review and 24 hours for an expedited review.

If you do not get a referral, Clever Care may not cover the service. For more information, call Customer Service or refer to Chapter 9 of your Evidence of Coverage.