Pre-Auth Check Tool

ATTENTION PROVIDERS: For authorization requests for date of service 1/1/18 and forward, utilize this tool to verify prior authorization requirements. To submit prior authorization by fax, please send to 866-597-7603.

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DISCLAIMER:

All attempts are made to provide the most current information on the Pre-Auth Needed Tool. However, this does NOT guarantee payment. Payment of claims is dependent on 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 are handled by EyeMed.

Dental Services are handled by Centene Dental.

Complex Imaging, MRA, MRI, PET and CT scans need to be verified by Evolent. 

Musculoskeletal services need to be verified by Turning Point

Chiropractic services are handled by American Specialty Health Network (ASH).

Medical and Radiation Oncology Biopharmacy drugs 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 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?
IS THE MEMBER RECEIVING GENDER REASSIGMENT SERVICES?
ARE SERVICES, OTHER THAN DME, ORTHOTICS, PROSTHETICS, SUPPLIES, X-RAYS, HOME VISITS (DOMICILIARY) CODES, HOME INFUSION OR LABS BEING RENDERED IN THE HOME?

To submit a prior authorization Login Here.