guide
MagnaCare prior authorization: which services need precertification
MagnaCare prior authorization starts with the employer’s plan. MagnaCare is a third-party administrator and provider network, so the plan sponsor decides what needs precertification. Its published guideline still names the services that generally do, and most therapy services are on that list.
This guide covers that list, how to send a MagnaCare precertification request, MagnaCare’s decision times and what happens after a denial.
At a glance
- MagnaCare is a TPA and provider network, part of Brighton Health Plan Solutions.
- The plan sponsor decides what needs precertification, and the phone number is on the ID card.
- Physical, occupational and speech therapy generally need precertification with MagnaCare.
- Elective services must be precertified at least 5 days before the scheduled date.
- MagnaCare decides within 15 days, or 72 hours for urgent requests.
“They are incredibly speedy with auth submission, so it is taking the heavy burden of submitting and having to follow up with payors off our internal team.”Kelsey S., Director of RCM (G2 review)Silna submits each MagnaCare request and follows up with the plan for you.Get started
What MagnaCare is and who sets the rules
MagnaCare is a third-party administrator and provider network that is part of Brighton Health Plan Solutions, which also runs the Create brand, according to MagnaCare’s network guidelines.
When a plan sponsor has chosen MagnaCare to run its medical management, providers send prior authorization requests through MagnaCare’s provider portal. The precertification phone number is on the member’s ID card. Two patients with MagnaCare cards can be on plans with different rules, so check each patient’s plan.
Services that usually need MagnaCare precertification
MagnaCare’s precertification guideline lists eight types of service that generally require precertification:
- Physical or occupational therapy
- Speech therapy
- Audiology services
- Chiropractic services
- Podiatric services
- Ambulatory surgery, in any setting
- High-tech radiology services
- Hyperbaric oxygen
ABA therapy isn’t on MagnaCare’s published list. That doesn’t mean a plan won’t require it, so call the number on the patient’s ID card before the first session.
How to send a MagnaCare precertification request
- Use MagnaCare’s provider portal when MagnaCare runs the plan’s medical management.
- Or fax an outpatient request to 516-723-7306.
- For questions, call Provider Services at 888-362-4624.
A paper or faxed request goes on MagnaCare’s Provider Prior Authorization Request Form, which asks you to attach clinical notes with the patient’s history and prior treatment.
Move every MagnaCare therapy request off your team’s fax line
MagnaCare’s decision times
MagnaCare publishes its own timing rules:
- 5 days
- minimum notice before an elective service
- 15 days
- for a standard decision
Urgent care requests get a decision within 72 hours. If an elective service isn’t precertified in time, MagnaCare says the member’s benefits may be reduced.
When MagnaCare denies a request
MagnaCare says ERISA appeal rights typically belong to the member, not the provider, unless the member authorizes the provider under the plan’s requirements, according to its dispute guideline. Get that authorization before you appeal for a patient.
An approval isn’t a promise of payment either. MagnaCare’s form says authorizations are based on medical necessity, appropriate coding and benefits. Silna’s guide covers how to appeal a prior authorization denial step by step.
Sending MagnaCare requests through Silna
Silna checks the patient’s plan requirements, submits the request with the documents it needs and follows up until a decision comes back. G2 reviewers rate Silna 4.8 out of 5 across 66 verified reviews.
“I love how much time Silna saves me. It cuts back the time I spend on so many of my tasks.”Sofie K., Authorization specialist (G2 review)Silna tracks the 5-day notice and the 15-day decision on every request.Get started
Key terms
- Third-party administrator (TPA)
- A company that runs a health plan’s claims and benefits for the plan sponsor without being the insurer.
- Plan sponsor
- The employer or other group that offers the health plan and decides what it covers.
- Precertification
- Approval of a planned service before it happens, also called prior authorization.
- Elective service
- A scheduled, non-urgent procedure or service.
Frequently Asked Questions
Does MagnaCare require prior authorization for physical therapy?
Generally, yes. Physical and occupational therapy are on MagnaCare’s list of services that generally require precertification, though the plan sponsor sets the final rules.
Where is the MagnaCare prior authorization form?
It’s the Provider Prior Authorization Request Form on magnacare.com. Attach clinical notes with the patient’s history and prior treatment.
What number do I call for MagnaCare precertification?
The number on the member’s ID card. MagnaCare’s Provider Services line is 888-362-4624.
How long does MagnaCare take to decide?
Within 15 days of receiving the request, or 72 hours for an urgent one.
This article is general educational information and does not give medical, legal or insurance advice. Each plan sponsor sets its own rules, so check the patient’s plan before you rely on it.
About the author
Jeffrey Morelli
Jeffrey Morelli is the Co-Founder and CEO of Silna Health, the first Care Readiness Platform built to remove the administrative barriers that delay care. Silna automates benefit checks, eligibility, and prior authorizations across 1,000+ payors, and is backed by $27M from Accel and Bain Capital Ventures. Before Silna, Jeff spent a decade in San Francisco building and scaling products for highly regulated industries, including leading go-to-market at Truework (Series C, acquired by Checkr).
Last updated: November 3, 2026.