Requesting Prior Authorization
For certain services or medications, your doctor must get permission from Clever Care beforehand — this is called prior authorization (pre-approval). Clever Care verifies the service or medication is medically necessary.
Medically necessary is a decision made by the health plan that says that your treatment, test, medication, or procedure is necessary to maintain or restore your health or to treat a diagnosed medical problem. To be covered, a service must meet this standard.
Services That Always Require Prior Authorization
The following services always require pre-approval (prior authorization), even from in-network providers:
- Hospitalization (non-emergency)
- Services outside Clever Care’s service area (non-emergency/non-urgent)
- Outpatient surgery
- Long-term care or skilled nursing services at a nursing facility
- Specialized treatments, imaging, testing, and procedures
- Non-emergency medical transportation services
- Major organ transplant
How to Request Prior Authorization
You, your representative, or your doctor can request a Prior Authorization by calling, faxing, or mailing information.
Call: 1-833-388-8168 (TTY: 711)
April 1–September 30: Monday–Friday, 8 a.m.–8 p.m.
October 1–March 31: Sunday–Saturday, 8 a.m.–8 p.m.
Fax: Send the Request for Prior Authorization form to 1-657-276-4179
Mail:
Clever Care
Attn: Utilization Management
7711 Center Avenue, Suite 100
Huntington Beach, CA 92647
When Will You Hear Back From Us
Response timelines:
- 72 hours for a fast (Urgent or Expedited) decision
- 7 calendar days in 2026 (or 14 calendar days in 2025) if the request is submitted before the service is performed
- 30 calendar days if submitted after the service is performed (no fast decision option available)
This page was last updated on October 8, 2025.