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Pre-Auth Check Tool | Ambetter from Arizona Complete Health
Pre-Auth Check Tool
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. Claim payment depends on member 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. All new, re-sequenced and unlisted codes (miscellaneous codes) require prior authorization, regardless of place of service.
Vision services need to be verified by Centene Vision ServicesExternal Link.
Dental services need to be verified by Centene Dental Services.External Link
The following services need to be verified by EvolentExternal Link: Complex Imaging, MRA, MRI, PET & CT scans.
The following services need to be verified by EvolentExternal Link: Medical and Radiation Oncology / Biopharmacy drugs.
Musculoskeletal services for shoulder, hip, spine and knee surgery need to be verified by Turning PointExternal Link.
Chiropractic services are managed by ASH.
Services provided by Out-of-Network providers are not covered by the plan, without prior authorization. Join Our NetworkExternal Link.
Are Services being performed in the Emergency Department?
Types of Services | YES | NO |
---|---|---|
Are the services being performed or ordered by a non-participating provider (professionals/facilities)? | ||
Is the member being admitted to an inpatient facility? | ||
Are anesthesia services being rendered for dental surgeries? | ||
Are oral surgery services being provided in the office? | ||
Is the member receiving Gender Affirming services? |
To submit a prior authorization Login HereExternal Link.
For Home Health, please request prior authorizations through Professional Health Care Network (PHCN)External Link
- Log into PHCN portalExternal Link
- Call PHCN at 602-395-5100
- Fax to 480-359-3834