Medicaid Pre-Auth
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.
Complex imaging, CT, PET, MRA, MRI, and high tech radiology procedures need to be authorized by RadMD.
Vision services need to be verified by Opticare
Dental Services need to be verified by our Dental Provider
Home Health requires Prior Authorization
Behavioral Health/Substance Abuse need to be verified by Centene Behavioral Health
Cardiac Services need to be verified by Turning Point
The following services are reviewed by Evolent ( formerly NIA)
Complex Imaging , CT PET MRA MRI and high tech radiology procedures
Musculoskeletal Services
Oncology/supportive drugs for members age 18 and older need to be verified by New Century Health
Non-participating providers must submit Prior Authorization for all services
For non-participating providers, Join Our Network
Prior Authorization at a Glance
Prior Authorization is NOT Required
The following services do NOT require prior authorization:
- Services rendered in an emergency room or urgent care center
- Services rendered by a public health or welfare agency
- Family planning services billed with a contraceptive management diagnosis
Prior Authorization IS Required
The following services REQUIRE prior authorization:
- Services rendered by an out out-of-network provider, with the exception of emergency and urgent care services
- Admission of a member to an inpatient facility
- Hospice services
- Anesthesia services for pain management or dental procedures.
- Services rendered at home, other than DME, orthotics, prosthetics, supplies and therapeutic injections
- Services rendered by a chiropractor
Prior Authorization Check
To submit a prior authorization Login Here