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Medicaid Pre-Auth

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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 Envolve Vision Services

Dental services, (D0000-D9999), need to be verified by Envolve Dental
Musculoskeletal, Complex Imaging, MRA, MRI, PET, CT Scans, High Tech Radiology and Cardiac need to be verified by Evolent

ENT and Cardiac Services need to be verified by TurningPoint

Behavioral Health/Substance Abuse need to be verified by Peach State Health Plan.



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?

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, Prosthetics and Sleep Studies and Home Health Administered Medications and Home Infusion?
Are anesthesia services being rendered for pain management?