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Pre-Auth Check Tool | Ambetter of Tennessee
Pre-Auth Check
/content/ambetter-tn/en_us/provider-resources/pre-auth-check
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.
The following services (identifiable by procedure code search) need to be verified by Evolent: Complex Imaging, MRA, MRI, PET, and CT scans; Speech, Occupational and Physical Therapy (excluding chiropractor specialty providers – no authorization required); Pain Management, Spinal Cord Stimulators and Musculoskeletal services for the spine, shoulder, hip and knee.
Behavioral Health services need to be verified by Ambetter of Tennessee.
Effective 9/1/2024, Cardiac Surgical services for Participating Providers and Members 18 years and older, need to be verified by New Century Health/Evolent.
Services provided by Out-of-Network providers are not covered by the plan. Join Our Network.
NOTE: Services related to an authorization denial will result in denial of all associated claims.
Are services being performed in the Emergency Department, or for Emergent Transportation?
| 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 reassignment services? |