Medicare Pre-Auth

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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 and correct coding and billing practices. For specific details, please refer to the Medicare Advantage provider manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response.

The following services need to be verified by Evolent.
Complex imaging, MRA, MRI, PET, and CT scan
Musculoskeletal services
Cardiac Services need to be verified by Turning Point

All Out of Network requests require prior authorization except emergency care, out-of-area urgent care or out-of-area dialysis.

Are Services being performed in the Emergency Department, or Urgent Care Center, or are the services for dialysis or Hospice?

Yes No

Types of Services	YES	NO
Is the member being admitted to an inpatient facility?	serviceQuestion-0	serviceQuestion-0
Are anesthesia services being requested for pain management, dental surgery or services in the office rendered by a non-participating provider?	serviceQuestion-1	serviceQuestion-1
Is this an HMO Out of Network service request?	serviceQuestion-2	serviceQuestion-2

Medicare Pre-Auth

Are Services being performed in the Emergency Department, or Urgent Care Center, or are the services for dialysis or Hospice?

Services being performed in the Emergency Department, or Urgent Care Center, or services for dialysis or Hospice do NOT require prior authorization

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

To submit a prior authorization Login Here.