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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. All new, re-sequenced and unlisted codes (miscellaneous codes) require prior authorization, regardless of place of service.

For Home Health, please request through Professional Health Care Network (PHCN)

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.

Musculoskeletal Services need to be verified by Turning Point

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

Transportation services are handled by Medical Transportation Brokerage of Arizona (MTBA).

 

Requests for elective clinical trials (S9988, S9990 and S9991) must
be submitted as expedited requests and with the completed
MEDICAID ATTESTATION FORM ON THE APPROPRIATENESS OF THE QUALIFIED CLINICAL TRIAL
found in the AHCCC Medical Policy Manual Section 320B.
 

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?
Are anesthesia services being rendered for dental procedures?
Are services, other than DME, orthotics, prosthetics, supplies, x-rays, home visits (DOMICILLARY) codes or labs being rendered in the home?
Are services being rendered in an unspecified location/place of service (other)?

To submit a prior authorization Login Here.

Prior Authorization (PA) Changes

Effective June 1, 2021 - PA Requirement Changes related to COVID Treatment and Telehealth services learn more [link to communication]

Please contact Provider Services if you have questions. If you need additional help please contact your Provider Engagement Specialist.

For oncology/supportive drugs, please request through New Century Health.

  • Log into New Century Health’s provider web portal at https://my.newcenturyhealth.com.
  • Submit an eFax to New Century Health at 1-213-596-3783 or send email to eFax email address at efax-carepro-oncology@newcentureyhealth.com
  • Contact New Century Health’s Utilization Management Intake Department at 1-888-999-7713, Option 2 (Monday through Friday, 5 a.m. – 5 p.m. PST)

Please note, failure to obtain authorization may result in administrative claim denials.
 

For Home Health, please request prior authorizations through Professional Health Care Network (PHCN)