Pre-Auth Check

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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, and 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.

Arkansas Total Care Q3 Pharmacy Prior Authorization and Step-therapy Data (CSV)
Arkansas Total Care Q3 Prior Authorization with Step-therapy and Exclusions Data (CSV)
Arkansas Total Care Q3 Clinical Policy History with Step-therapy and Exclusions Data (CSV)

Vision Services need to be verified by Envolve Vision.

Dental Services are provided through Delta Dental or MCNA. Please verify.

Complex imaging, MRA, MRI, PET, and CT scans need to be verified by NIA.

Prior Authorizations for Musculoskeletal Procedures should be verified by TurningPoint.

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, or are these family planning services billed with a contraceptive management diagnosis?

Yes No

Types of Services	YES	NO
Is the member being admitted to an inpatient facility?	serviceQuestion-0	serviceQuestion-0
Are anesthesia services being rendered for pain management?	serviceQuestion-1	serviceQuestion-1
Are oral surgeon services being rendered in the office?	serviceQuestion-2	serviceQuestion-2
Are chiropractic services being rendered?	serviceQuestion-3	serviceQuestion-3
Are services, other than DME, orthotics, prosthetics, and supplies, being rendered in the home?	serviceQuestion-4	serviceQuestion-4
Are hospice services being provided?	serviceQuestion-5	serviceQuestion-5

Pre-Auth Check

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

Services being performed in the Emergency Department or Urgent Care Center or Family Planning services billed with a Contraceptive Management diagnosis do NOT require prior authorization

Enter the code of the service you would like to check:

To submit a prior authorization Login Here.

Pre-Auth Check

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

Services being performed in the Emergency Department or Urgent Care Center or Family Planning services billed with a Contraceptive Management diagnosis do NOT require prior authorization

Enter the code of the service you would like to check:

To submit a prior authorization Login Here.

Arkansas Total Care Prior Authorization Statistics