Skip to Main Content

MyCare Ohio Pre-Auth

DISCLAIMER: Your current browser's security settings does not allow the use of this tool. This tool requires the use of Internet Explorer 10 or Later. If you are currently using Internet Explorer as your browser and you see this message, you should try to update it or use another browser like Google Chrome or Firefox.
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.

Behavioral Health/Substance Abuse need to be verified by Cenpatico

The following services need to be verified by Evolent.

Complex imaging, MRA, MRI, PET, and CT scan Musculoskeletal services.

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 FQHC, or are the services for dialysis or Hospice?

Types of Services YES NO
Is a non-par provider rendering services other than lab, radiology or flu/pneumonia shots?
Is the member being admitted to an inpatient facility?
Are anesthesia services being requested for pain management, dental surgery or services in the office rendered by a non-participating provider?