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Did You Know?

  • Step 1: From the Provider Home Page (PHP), select Prior Authorizations, then select Pre-Auth Check.
  • Step 2: Select the applicable plan: Ambetter, Medicaid, Medicare or MyCare to open the correct tool.
  • Step 3: Be sure to read the Disclaimer in full.
  •             Note: All out-of-network providers require a prior puthorization.
  • Step 4:  Answer the series of questions.
    • Please note:
      •  If the answer is ‘yes’ to the first question (Are services being performed in the….), then NO authorization is required.
      • If the answer is ‘no’ you will continue on to answer the rest of the questions.
        • If at any time on the remaining questions the answer is ‘Yes’ it will notify you that a Prior Authorization is required and ask you to Log In to submit it.
        • If the answer is ‘no’ on all remaining questions, the tool will ask for the code you are checking.  NOTE: Leaving any empty spaces after the 5 digit code will generate an error.
          • When entered properly it will indicate if an authorization is necessary:
            •  Authorization is not needed – green ‘no’.
            • Authorization is required – red ‘yes’. You will need to log in and submit the prior authorization.

Special note for the MyCare Tool

  • You may see other responses after submitting the code:
    • C-Conditional: Means there are certain conditions when PA is required, i.e., the allowable therapy visits have been used.
      • You will need to submit an authorization request for final determination by our UM Department.
    • Y-Yes: Pre-authorization required for all providers. Please enter authorization in Medicaid.
    • ·Green ‘No:’ The procedure code is not a covered benefit under the Buckeye Community Health Plan.
    • ·Orange “Maybe”:  This means there are other outlying indicators not able to be answered with a simple “yes” “no” and need final determination by our UM Department. An authorization submission is suggested.

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