Health Information Technology   Preauthorization  

Electronic Preauthorization


Md. Code Ann., Health-General Article § 19-108.2, (law) established four benchmarks, which aim to create administrative efficiencies in the preauthorization process by eliminating paper-based processes and enabling the electronic submission of preauthorization requests. The law required MHCC to work with State-regulated insurers, nonprofit health service plans, health maintenance organizations and pharmacy benefits managers (PBMs) (collectively “payors”) in implementing the benchmarks. 

Benchmark 1 - Provide online access to a listing of medical services and pharmaceuticals requiring preauthorization and the key criteria for making a determination

Benchmark 2 - Establish an online system to receive preauthorization requests electronically and assign a unique identification number to each request for tracking purposes.

Benchmark 3 - Process all electronic preauthorization requests within established timeframes – for pharmaceuticals, in real-time or within one business day upon receiving all pertinent information; and for medical services, within two business days upon receiving all pertinent information.

Benchmark 4 - Establish an electronic process to allow health care providers to override a step therapy or fail-first protocol when submitting an electronic pharmaceutical preauthorization request.


The law required MHCC to report annually to the Governor and General Assembly through 2016. The final report submitted by MHCC can be accessed here. Previous reports can be accessed here.

Payors' & PBMs' Online Portals

Included below are links to payors’ and PBM’s online preauthorization systems.

*For certain carriers, providers should login to the online portal on the right menu; from there, they will be able to submit medical and pharmacy preauthorization requests.   


1.   Aetna          

2.   CareFirst BlueCross BlueShield          

3.   Cigna Healthcare Mid-Atlantic Region          

4.   Coventry Health Care of Delaware          

5.  UnitedHealthcare        


  1. CVS Caremark  
  2. Express Scripts  
  3. OptumRX  

Benchmark Waiver Requests

The law gave MHCC authority to adopt regulations to establish a process by which a payor may be waived from attaining one or more of the benchmarks. COMAR details the waiver process. All initial waiver requests or requests to renew a waiver should be submitted to Eva Lenoir at 


Last Updated: 3/8/2018