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.
For non-participating providers, Join Our Network.
Are services being performed in the Emergency Department, Urgent Care Center, Family Planning Services or Local Health Department, or 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 Surgeries?|
|Are oral surgery services being provided in the office?|
|Are services, other than Sleep Studies, DME, orthotics, prosthetics, and supplies, being rendered in the home?|
|Is the member receiving hospice services?|
|Are the services being provided by a chiropractor for a member under the age of 21?|