Medicaid 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 upon 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 need to be verified by Opticare
Dental services, (D0000-D9999), need to be verified by Dental Health & Wellness
Complex Imaging, MRA, MRI, PET, CT Scans need to be verified by NIA
Behavioral Health/Substance Abuse need to be verified by Cenpatico

Non-participating providers must submit prior authorization for all services.
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?

Services being performed in the Emergency Department or Urgent Care Center or Family Planning services billed with a contraceptive management diagnosis do NOT require prior authorization

Types of Services YES NO
Is the member being admitted to an inpatient facility?
Are services being rendered in the home, excluding DME, Medical Equipment Supplies, Orthotics and Prosthetics?
Are anesthesia services being rendered for pain management
This service requires prior authorization.
Login Here to submit authorization

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