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 upon eligibility covered benefits, provider contracts and correct coding and billing practices. For specific details, please refer to the PROVIDER OPERATIONS MANUAL. If you are uncertain that prior authorization is needed, please submit a request for an accurate response.
Vision services need to be verified by OPTICARE.
Dental services need to be verified by calling 1-844-876-2028.
Transportation services except for fix wing need to be verified by the Transportation Vendor.
Complex imaging, MRA, MRI, PET, and CT Scans need to be verified by NIA.
Behavioral Health services are handled by MMIC.
Chiropractic services are handled by ASH.
Non-participating providers must submit Prior Authorization for all services except those performed in the Emergency Department and Urgent Care.
For non-participating, Join our network
Are Services being rendered in the Emergency Room, Urgent Care or Family Planning services billed with a Contraceptive Management diagnosis?
|Types of Services||YES||NO|
|Is the member being admitted to an inpatient facility or observation stay exceeding 24 hours?|
|Is the patient receiving Hospice Services? Are services being rendered by a Hospice Provider?|
|Are anesthesia services being rendered for dental surgery?|
|Are Home Care Services, other than DME, orthotics, prosthetics, supplies, x-rays or labs being rendered?|