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. 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?