Authorization numbers are not required for the following; the service can be completed with a referral or an order from your primary care physician or specialist:
- Most office visits and office-based procedures for local network participating practitioners 
- Ambulatory Surgical Center procedures performed at local network participating facilities
- Outpatient hospital procedures and services (excluding wound care, hyperbaric oxygen treatment, and observation lasting more than 48 hours, which continue to require an authorization) performed at local network participating hospitals
- Participating out-of-area practitioners and OP facilities (i.e. University of Florida Health a.k.a. Shands/Gainesville and Nemours Children's Clinics)
- Tallahassee Memorial Center for Pain Management (a.k.a. Tallahassee Neurology Pain Management Facility)
- Mammography or ultrasound to detect abnormality in the breast, including those performed at a local participating hospital
- Mastectomy bras and prosthetics as allowed under the member's group benefit package at local participating providers
- Blood and blood products received in a local participating outpatient hospital facility
- OB labor checks at a local participating outpatient hospital facility
- Ostomy supplies obtained from Medical Care Products
- DME and oxygen obtained from American Home Patient Care (in the service area), Barnes Healthcare Services, and Desloge Home Oxygen & Medical Equipment
- Sleep studies performed at Tallahassee Memorial Outpatient Sleep Center
- Home Health Care services
- Hospice home-based services
- DaVita dialysis services 
- Physical therapy and occupational therapy obtained from TMH outpatient Rehabilitative Services and the Center for Orthopedic and Sports Physical Therapy (up to benefit limits)
- Most outpatient diagnostic imaging at local participating radiology locations
- Intensive outpatient substance abuse treatment with local participating network practitioners
- Services rendered in a medical emergency
- LabCorp network lab. Local outpatient physicians and hospitals should use LabCorp for routine lab work.
Authorization numbers are required for the following:
- All inpatient services
- Outpatient hospital-based services for wound care, hyperbaric oxygen treatment (HBO), and observation lasting more than 48 hours
- All non-participating practitioners or facilities in or out of CHP's service area
- All services related to the mouth and/or teeth
- Speech therapy
- Applied Behavioral Analysis (ABA) therapy
- Nutritional counseling
- Kelly Lang, M.D., practicing at TMH Bariatric Center
- Services that may be investigational or outside the realm of accepted mainstream medical care
- All procedures or surgery that has CHP clinical criteria requires review and an authorization at any location. See a listing of Capital Health Plan Clinical Criteria on the Medical Policies page.
The following are just a few of the services that have clinical criteria and require a review and a prior authorization:
- Genetic testing
- Back (lumbar) and neck (cervical) MRIs
- Back (lumbar) and neck (cervical) surgery (also known as spinal surgery)
- Hip Arthroplasties (also known as total hip replacement)
- Transcranial Magnetic Stimulation
- Implantable hearing devices
- Certain Durable Medical Equipment (DME), such as: external insulin infusion pumps & supplies, continuous glucose monitoring, and power wheelchairs.
- Certain medications when obtained under the medical benefit, refer to the Medication Center for more information.
 Contact Capital Health Plan’s Member Services Department for further information on which local participating practitioner services still require an authorization
 Dialysis services received outside of Capital Health Plan’s service area may necessitate receiving services from a facility other than DaVita – you should work with your local DaVita facility to coordinate these services prior to leaving the service area.
 You and your primary care physician have access to Capital Health Plan’s utilization management clinical criteria through CHPConnect. You may also request a list of Capital Health Plan’s clinical criteria by contacting the Member Services Department.