Ambetter Pre-Auth Needed?

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.

Vision services including all services rendered by an Optometrist need to be verified by Opticare
Dental services need to be verified by Dental Health & Wellness
Behavioral Health/Substance Abuse need to be verified by Cenpatico
Home Health and Durable Medical Equipment need to be verified by Peach State Health Plan.
Complex imaging, MRA, MRI, PET, and CT Scans need to be verified by NIA

Services provided by Out-of-Network providers are not covered by the plan. Join Our Network

Note: Services related to an authorization denial will result in denial of all associated claims.

Are Services being performed in the Emergency Department?

Services being performed in the Emergency Department do NOT require prior authorization

Types of Services YES NO
Are the services being performed or ordered by a non-participating provider
Is the member being admitted to an inpatient facility?
Are anesthesia services being rendered for pain management or dental surgeries?
Is the member receiving hospice services?
Are services being rendered in the home, excluding Sleep Studies, DME, Medical Equipment Supplies, Orthotics and Prosthetics?
This service requires prior authorization.
Login Here to submit authorization

Enter the code of the service you would like to check: