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 Medicare Advantage provider manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response.
Complex imaging, MRA, MRI, PET and CT scans need to be verified by NIA.
Musculoskeletal and Cardiac surgical services need to be verified by Turning Point.
Non-participating providers must submit Prior Authorization for all services when treating HMO members.
For non-participating providers, Join Our Network
Are services being performed in the Emergency Department or Urgent Care Center, or are the services for dialysis or hospice?
|Types of Services||YES||NO|
|Is the member being admitted to an inpatient facility?|
|Are anesthesia services being rendered for pain management, dental surgery, or services in the office rendered by a non-participating provider?|
|Is the member receiving gender reassignment services?|
|Is this an HMO Out of Network service request?|