Medicaid Prior 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 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 Dental Health and Wellness.
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.

Would this be Emergency or Urgent Care, Dialysis, FQHC, DOH, RHC or are these family planning services billed with a contraceptive management diagnosis?

Types of Services YES NO
Is the member being admitted to an inpatient facility?
Are anesthesia services being rendered for pain management or dental procedures?
Are plastic surgeon services being rendered in the office?
Are podiatry services being provided after the third visit?
Are chiropractic services being rendered after the 12th visit?
Are services, other than DME, orthotics, prosthetics, and supplies, being provided in the home?
Are hospice services being provided?