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Medicaid Pre-Auth

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DISCLAIMER:

All attempts are made to provide the most current information on the Pre-Auth Needed Tool. However, this does NOT guarantee payment. Payment of claims is dependent on eligibility, covered benefits, provider contracts, correct coding and billing practices. For specific details, please refer to the provider manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response.

Preventative Vision Services need to be verified by Envolve Vision

Dental Services need to be verified by Envolve Dental.

Complex imaging, MRA, MRI, PET, and CT scans need to be verified by NIA.

Chiropractic services are handled by American Specialty Health Network (ASH).

Non-participating providers must submit Prior Authorization for all services except those performed in the Emergency Department and Urgent Care.

For non-participating providers, Join Our Network.

Are Services being performed in the Emergency Department or Urgent Care Center or Family Planning services billed with a Contraceptive Management diagnosis?

Types of Services YES NO
Is the member being admitted to an inpatient facility?
Is the patient receiving Hospice Services? Are services being rendered by a Hospice Provider?
Are anesthesia services being rendered for dental procedures?
Are services, other than DME, orthotics, prosthetics, and supplies, x-rays or labs being rendered in the home?