MEDICARE MEMBERS: PROTECT YOURSELF AGAINST MEDICARE FRAUD AND IDENTIFY THEFT! THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF INSPECTOR GENERAL IS ALERTING THE PUBLIC ABOUT A FRAUD SCHEME INVOLVING GENETIC TESTING. LEARN HOW TO PROTECT YOURSELF.
Medicare Pre-Auth
DISCLAIMER:
All attempts are made to provide the most current information on the Pre-Auth Needed Tool. A prior authorization is not a guarantee of payment. Payment may be denied in accordance with Plan’s policies and procedures and applicable law. 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.
Dental Services are handled by Your Dental Plan.
Vision Services are handled by EyeMed.
High Tech Imaging services are handled by NIA.
Behavioral Health services are handled by MHN.
Chiropractic services are handled by ASH.
Orthopedic/Musculoskeletal services are handled by TurningPoint.
Oncology/supportive drugs for members age 18 and older need to be verified by New Century Health.
All Out of Network requests for members in an HMO plan require prior authorization except emergency care, out-of area urgent care or out-of-area dialysis.
Are services being performed in the Emergency Department, Urgent Care, Emergent Transportation, Dialysis, or for Hospice?
| Types of Services | YES | NO |
|---|---|---|
| Is the member being admitted to an inpatient facility? | ||
| Is the member receiving gender reassignment services? | ||
| Are anesthesia services being required for pain management or services in the office rendered by a non-participating provider? | ||
| Is this an HMO out-of-network service request? |