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.
All Out of Network requests require prior authorization except emergency care.
For non-participating providers, Join Our Network
Are Services being rendered in the Emergency Room?
|Types of Services||YES||NO|
|Is the member being admitted to an inpatient facility or observation stay exceeding 24 hours?|
|Is the patient receiving Hospice Services? Are services being rendered by a Hospice Provider?|
|Are anesthesia services being rendered for pain management or dental anesthesia?|
|Are Home Care Services, other than DME, orthotics, prosthetics, supplies, x-rays or labs being rendered?|
|Are Chiropractic Services being provided to members under 21 years of age?|