Medicare Pre-Auth

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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.

Chiropractic services are handled by ASH.

Oncology/supportive drugs for members age 18 and older need to be verified by New Century Health.

The following services need to be verified by Evolent.

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

Musculoskeletal services

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?

Yes No

Types of Services	YES	NO
Is the member being admitted to an inpatient facility?	serviceQuestion-0	serviceQuestion-0
Is the member receiving gender reassignment services?	serviceQuestion-1	serviceQuestion-1
Are anesthesia services being required for pain management or services in the office rendered by a non-participating provider?	serviceQuestion-2	serviceQuestion-2
Is this an HMO out-of-network service request?	serviceQuestion-3	serviceQuestion-3

Medicare Pre-Auth

Are services being performed in the Emergency Department, Urgent Care, Emergent Transportation, Dialysis, or for Hospice?

Prior Authorization is NOT required.

Enter the code of the service you would like to check:

To submit a prior authorization Login Here.