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Medicare Pre-Auth

Attention Providers: For authorization requests for date of service 1/1/18 and forward, utilize this tool to verify prior authorization requirements. To submit prior authorization by fax, please send to 877-808-9362.

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DISCLAIMER:

All attempts are made to provide the most current information on the Pre-Auth Needed Tool. A prior authorization is not a guarantee of payment. Payment may be denied in accordance with Plan’s policies and procedures and applicable law. 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.

Vision Services are managed by Envolve Vision, administered by EyeMed.

Dental Services for Medicare are administered by Dental Benefits Partners (DBP).

Dental Services for Dual Medicare (D-SNP) are administered by Envolve Dental.

High Tech Imaging services are handled by NIA.

Radiation Therapy and Sleep Studies are handled by Evicore.

Behavioral Health services are handled by MHN.

Chiropractic services are handled by ASH.

Transportation services are handled by Veyo.

 

All Out of Network requests require prior authorization except emergency care, out-of area urgent care or out-of-area dialysis.

 

Are services being performed in the Emergency Department, Urgent Care, Emergent Transportation, Dialysis, or for Hospice?

Types of Services YES NO
IS THE MEMBER BEING ADMITTED TO AN INPATIENT FACILITY?
IS THE MEMBER HAVING GENDER REASSIGNMENT SERVICES?
ARE ANESTHESIA SERVICES BEING REQUIRED FOR PAIN MANAGEMENT OR SERVICES IN THE OFFICE RENDERED BY A NON-PARTICIPATING PROVIDER?
ARE SERVICES OTHER THAN LAB, RADIOLOGY, DOMICILIARY VISITS OR DME BEING RENDERED IN THE HOME?