Skip to Main Content

Medicare Pre-Auth

DISCLAIMER: Your current browser's security settings does not allow the use of this tool. This tool requires the use of Internet Explorer 10 or Later. If you are currently using Internet Explorer as your browser and you see this message, you should try to update it or use another browser like Google Chrome or Firefox.

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.

The following services need to be verified by Evolent:

Complex imaging, MRA, MRI, PET, and CT scan

Musculoskeletal services

Cardiac surgical services


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?
Last Updated: 01/17/2024