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Medicaid Pre-Auth

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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, 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.

Vision services need to be verified by Envolve Vision.

Dental services need to be verified by Envolve Dental.

Ambulance and Transportation services need to be verified by LCP Transportation.

Musculoskeletal services need to be verified by Evolent.

Complex imaging, MRA, MRI, PET, CT scans, PT, ST, OT and Pain Management need to be verified by Evolent.

Medication under the pharmacy benefit needs to be verified by State Unified PDL. 

 

Non-participating providers must submit Prior Authorization for all services. 

For non-participating providers, join our network.

 

Are services being performed in the Emergency Department or Urgent Care Center 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 services for infertility?

To submit a prior authorization Login Here.

2023 30 Most Frequently Submitted CPT Codes (PDF)

Last Updated: 09/25/2024