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
Non-participating providers must submit Prior Authorization for all services.
Would this be Emergency or Urgent Care, Dialysis 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?|
|Are oral surgeon services being rendered in the office?|
|Are chiropractic services being rendered?|
|Are services, other than DME, orthotics, prosthetics, and supplies, being rendered in the home?|
|Are hospice services being provided?|