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 NIA
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
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
Are Services being performed in the emergency department, FQHC, public health or public welfare agency, or are these family planning services billed with a contraceptive management diagnosis?
|Types of Services
|Is the member being admitted to an inpatient facility?
|Are services other than home health aide, home therapies (PT/OT/ST), DME, orthotics, prosthetics and supplies being rendered in the home?
|Is the member receiving hospice services?
|Are anesthesia services being rendered for pain management or dental surgeries?
|Are plastic or oral surgeon services being rendered?