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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.

We have separate fax numbers for Medicaid and Medicare pre-authorizations. Please make sure you use the correct fax number to expedite your request. Medicaid FAX: 1-866-467-1316. If your request is for a Medicare recipient, please use this number: 1-877-687-1183.
       

 

Step-Therapy

In some cases, it is required that our members first try a certain medication to treat their medical condition before another medication is covered. For example, Medication A and Medication B both treat the member's medical condition. Medication B may not be covered unless the member tries Medication A first. If Medication A does not work for our member, Medication B will be covered.

 

Use the form below to check if preauthorization is required. Print a copy of your results for your records.

Are Services being performed by an Ambulatory Surgical Center or are they 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 or dental surgery?
Are services being rendered in the home other than DME, orthotics, prosthetics, supplies, sleep studies, or 99381-99387, 99391-99397, 90476-90748 if rendered by a PCP or health department?
Are podiatry services being rendered after the 3rd visit in a year?