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.
Are Services being performed in the Emergency Department or Urgent Care Center or Family Planning services billed with a Contraceptive Management diagnosis?
|Types of Services||YES||NO|
|Is the member being admitted to an inpatient facility?|
|Is the member having an Observation stay?|
|Are anesthesia services being rendered for pain management?|
|Are oral surgery services being provided in the office?|
|Are chiropractic services being rendered after the 4th visit?|
|Are services being rendered in the home, excluding DME, Medical Equipment Supplies, Orthotics, Prosthetics and sleep studies?|