Pre-Auth Needed?

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.

Vision Services need to be verified by Opticare.
Dental Services need to be verified by DentaQuest.
Complex imaging, MRA, MRI, PET, and CT scans need to be verified by NIA.
Behavioral Health/Substance Abuse need to be verified by Cenpatico.

Non-participating providers must submit Prior Authorization for all services.
For non-participating providers, Join Our Network.

Emergency and Urgent Care Services do NOT require prior authorization.

Type of service Authorization Required?
The information below supersedes responses by the code lookup tool.
Inpatient Confinement YES
Anesthesia services for pain management or oral surgery YES
Plastic surgeon services rendered in the office YES
Podiatry services after the third visit YES
Chiropractic services after the 12th visit YES
Home locations YES
Hospice services YES
Dialysis services NO
FQHC, DOH, and RHC NO
Family Planning services billed with a V25 through V25.9 diagnosis NO

    If an authorization is required for the requested procedure, to submit an authorization Login here.