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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.
Complex imaging, MRA, MRI, PET & CT scans; Left Heart Catheterization & Implantable services need to be verified by NIA.
Physical therapy (PT), occupational therapy (OT), and speech therapy (ST) need to be verified by NIA.
Behavioral Health services need to be verified by Ambetter from Absolute Total Care
Oncology/supportive drugs for members age 18 and older need to be verified by New Century Health
Post-acute facility (SNF, IRF, and LTAC) prior authorizations need to be verified by CareCentrix; Fax 877-250-5290
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?|
|Is the member being admitted to an inpatient facility?|
|Are anesthesia services being rendered for dental surgeries?|
|Is the member receiving gender reassignment services?|